The impact of Candida albicans colonization in the airway on ventilator-associated pneumonia caused by Pseudomonas aeruginosa
Objective To investigate the impact of Candida albicans colonization on the mortality,duration of antibiotic therapy,immune and inflammation status in patients with ventilator-associated pneumonia(VAP)caused by multidrug-resistant Pseudomonas aeruginosa.Methods This prospective multicenter cohort study included patients with VAP caused by multidrug-resistant Pseudomonas aeruginosa(MDR-Pa)admitted to six tertiary teaching hospitals from June 2018 to June 2023.The patients were divided into colonization group and non-colonization group based on the presence of Candida albicans detected in the broncho-alveolar lavage fluid(BALF).The 30-d all-cause mortality,duration of antibiotic therapy,immune and inflammation status were compared between the two groups after VAP diagnosis on the day1,day3,day5,and day7.Results During the five-year research period,a total of 232 VAP patients caused by MDR-Pa were included from six participating units in the intensive care unit(ICU),with 105 cases in the colonization group and 127 cases in the non-colonization group.The Pseudomonas aeruginosa detected in BALF samples from the non-colonization group showed higher sensitivity to aminoglycosides,cephalosporins,and carbapenems compared to the colonization group(P<0.05).However,both groups showed lower sensitivity to 16 antibiotics compared to China antimicrobial surveillance network(CHINET)2022(P<0.05).Interleukin-17A and(1,3)-β-D glucan levels in the non-colonization group were consistently lower than those in the colonization group at various time points,and other inflammatory markers were more likely to return to normal values(P<0.05).Additionally,the absolute values of T and Th lymphocytes in the non-colonization group recovered to normal levels faster on the day 7(P<0.05).There was no statistically significant difference in the 30-d all-cause mortality between the two groups(25.7%vs 22.8%,P= 0.61),but the non-colonization group had a significantly shorter duration of antibiotic therapy compared to the colonization group[(11.3±3.1)d vs(14.2±4.7)d,P<0.01],with a trend towards shorter ICU hospitalization time.Conclusion The colonization of Candida albicans in the airway does not affect the 30-d all-cause mortality of patients with VAP caused by MDR-Pa.However,it does prolong the inflammatory response and the duration of antibiotic use,as well as delay the recovery of immune function.
NETL
NSTL
万方数据
维普
