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. 2018 Nov;25(6):197-201.
doi: 10.1097/CPM.0000000000000279.

Respiratory Tract Colonization by Candida species Portends Worse Outcomes in Immunocompromised Patients

Kathryn M Pendleton  1 , Robert P Dickson  2 , Duane W Newton  3 , Timothy C Hoffman  4 , Gregory A Yanik  5 , Gary B Huffnagle  2   6   7   8
Affiliations

Respiratory Tract Colonization by Candida species Portends Worse Outcomes in Immunocompromised Patients

Kathryn M Pendleton et al. Clin Pulm Med. 2018 Nov.

Abstract

Background: The significance and clinical management of Candida colonization of the respiratory tract are ill-defined. We now report the frequency of Candida species from the lower respiratory tract in hematopoietic stem cell transplant recipients (HSCT) undergoing bronchoscopy with broncheoalveolar lavage (BAL) for pneumonitis post-HSCT.

Methods: The University of Michigan Clinical Microbiology Lab Database was queried for all respiratory cultures positive for Candida species between 2000-2012. We concurrently performed a retrospective analysis of 515 HSCT recipients with pneumonitis at our institution between 2001-2012.

Results: During this twelve-year period, there were 2524 unique Candida isolates (78% Candida albicans). Of the 515 HSCT patients with suspected pneumonitis,127 (24.7%) HSCT subjects were culture positive for a fungal pathogen, with Candida species identified in 27 cases (5.2%). When compared with other HSCT subjects, those cultures positive for Candida had significantly increased mortality (p=0.04).

Conclusions: Candida sp. are commonly cultured from the respiratory tract of HSCT recipients, with increased mortality in affected patients. While there is insufficient evidence for anti-fungal treatment of Candida species colonization, the presence of the yeast may be useful as a surrogate marker of disease severity.

Keywords: Candida; Hematopoietic Stem Cell Transplant; Respiratory Tract Colonization.

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Conflict of interest statement

The authors have no financial or non-financial conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:. Candida isolation from the respiratory tract is associated with increased mortality in immunocompromised patients.
(A) When compared with subjects from which only non-pathogenic fungi were isolated (Candida negative group), those who were culture positive for Candida had significantly increased mortality (p=0.04). (B) There was no statistical difference in mortality between subjects in which a pathogenic fungus was cultured (e.g., Aspergillus, Pneumocystis, Mucor, etc.) and those in which a Candida species was cultured (p=0.24). Kaplan-Meier survival curves were used for all survival analyses with log-rank p-values reported. Data were analyzed using GraphPad Prism 7 (San Diego, CA).
See this image and copyright information in PMC

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