Of the 386 patients who were selected according to the nested exposed/unexposed analysis (model 1), extrapulmonary Candida colonization was found in 85 patients (39.7%) with respiratory tract Candida colonization but in only 49 unexposed patients (8.3%). Moreover, extrapulmonary Candida colonization was more common and more extensive in exposed than in unexposed patients. As shown in Table 1, exposed patients were older, had a higher LOD score at ICU admission, were more frequently admitted for acute respiratory failure or infection and less frequently for coma, and were more likely to have received antibiotics within the first 3 days in the ICU. Antifungal therapy was prescribed more frequently in patients with respiratory tract Candida colonization than in other patients (7.5% vs 2.9%, p = 0.0038).
As shown in Table 1, respiratory tract Candida colonization was associated with a longer time on MV and longer durations of ICU and hospital stays. birth control pills online
However, ICU and hospital mortality rates were not significantly different between patients with and without colonization. Candidemia occurred in six patients, including two patients (0.9%) with and four patients (0.7%) without respiratory tract Candida colonization. In the matched exposed-unexposed (1:n) analysis, 191 colonized patients free from VAP at colonization time were the exposed patients. In the exposed patients, 46 acquired VAP (24.1%). In exposed patients, the mean time from onset of respiratory tract Candida colonization to VAP was 5 days (range, 2 to 7 days). The unexposed population consisted of 612 patients without Candida colonization before VAP. Three hundred eighty-six patients were selected according to the matching procedure; 68 patients (17.6%) had a VAP episode. The results of the matched exposed/unexposed nested cohort are reported in Table 2. In a model comparing 191 exposed patients to 386 matched unexposed patients, the OR for VAP due to any organism was 1.55 (95% CI, 1.01 to 2.38; p = 0.047) but did not remain significant after careful adjustment. We found no significant association between respiratory-tract Candida colonization and S aureus VAP. On the contrary, we found an independent association between respiratory-tract Candida colonization and VAP was significant only for Pseudomonas (adjusted OR for Pseudomonas VAP, 2.22; 95% CI, 1.00 to 4.92; p = 0.049).
Table 2—Results of the Nested Exposed/Unexposed (1:n) Analysis
|Models||Matching Variables||Pairs Successfully Matched, %||Outcome Variable of Interest||Patients, No.||Results, No.|
|1||Center; year of ICU admission; duration of MV greater or equal to time to occurrence of Candida colonization of the respiratory tract||100||VAP episodes||191 exposed; 386 unexposed||Exposed, 46(24.1% of VAP); unexposed, 68 (17.1% of VAP); unadjusted OR,1.55 (95% CI, 1.01 to 2.38; p = 0.047); adjusted OR, 1.58 (95% CI, 0.94 to 2.68; p = 0.086)|
|2||Center; year of ICU admission; duration of MV greater or equal to time to occurrence of Candida colonization of the respiratory tract||100||P aeruginosa VAP episodes||211 exposed; 394 unexposed||Exposed, 19 (9% of P aeruginosa VAP); unexposed, 19 (4.8% of P aeruginosa VAP); unadjusted OR, 1.99(95% CI, 1.01 to 3.93; p = 0.047); adjusted OR, 2.22 (95% CI,1.00 to 4.92; p = 0.049)|
|3||Center; year of ICU admission; duration of MV greater than or equal to time to occurrence of Candida colonization of the respiratory tract||100||S aureus VAP episodes||207 exposed; 398 unexposed||Exposed, 18 (8.7% of S aureus pneumonia); unexposed,28 (7% of S aureus pneumonia); unadjusted OR, 1.38 (95% CI, 0.71 to 2.69; p = 0.3); adjusted OR,
1.27 (95% CI, 0.57 to 2.85; p = 0.6)