Using an experimental burned-mouse model, Neely and colleagues showed that recent Pseudomonas infection increased the risk of fatal candidiasis. Molecular studies identified phylogenetic similarities between the two pathogens, and Hogan et al reported that Candida morphology and virulence were significantly affected by the presence of P aeruginosa.
To look for an association between Candida colonization of the respiratory tract and subsequent Pseudomonas VAP, we performed a data collection of Candida colonization in immunocompetent critically ill patients who received MV for > 2 days. We compared the incidence of VAP in patients with Candida colonization of the respiratory tract (exposed group) and in paired, matched control subjects (unexposed group). Source
The Institutional Review Board of the French Society of Critical Care approved the inclusion of critically ill patients in the Outcomerea database. Patients and family members gave their informed consent that anonymous data would be collected and entered into the database. We conducted a prospective observational study in the multicenter Outcomerea database, which is specifically designed to record daily disease severity and occurrence of iatrogenic events and nosocomial infections. Between January 2000 and December 2003, Candida colonization was prospectively collected in a selected subsample of the Outcom-erea database. All patients > 18 years old requiring > 2 days of MV were included. We excluded patients with immunodeficiency (HIV infection, neutropenia, solid cancer, hematologic malignancy, solid-organ or bone marrow transplantation, or long-term [> 3 months] or high-dose [> 1 mg/kg] steroid treatment). All six study ICUs followed the same management protocol for nosocomial pneumonia and Candida colonization and infection. This protocol was not changed for the present study.