Mean platelet volume can predict subsequent Candida spp. airway colonization in mechanically ventilated subjects

Abstract

Background: Despite the association between the airway colonization with Candida spp and impaired ICU outcomes of critically ill patients, little is known whether Candida colonization in respiratory tracts could be predicted with simple blood tests. The present study aims to investigate whether admission blood tests could provide information regarding the further Candida spp airway colonization in patients admitted to the ICU for MV. Materials and Methods: A hundred patients who were admitted to the ICU of our institute for invasive MV for more than 4 days were enrolled in this retrospective study. Venous blood samples were drawn upon admission for measurement complete blood count, procalcitonin, and C-reactive protein (CRP). Endotracheal aspirates were also obtained by 7 days intervals to identify Candida spp. airway colonization. Rapid assimilation or agglutination tests and API 20C AUX were performed for the identification of Candida spp. Results: Mean platelet volume was significantly higher in subjects who developed Candida spp. airway colonization compared to subjects without Candida spp. airway colonization during the ICU stay (10.5 ± 1.3 fl vs. 9.4 ± 1.4 fl, p <0. 001). Logistic regression analysis revealed that among the parameters studied, only MPV was a significant predictor for the development of Candida spp. airway colonization during the ICU stay (OR: 1.992, 95%CI: 1.289-3.078, p= 0.002). Conclusions: Mean platelet volume, a simple and readily available marker of the inflammatory state, can be used in the prediction of the subsequent Candida spp. airway colonization in mechanically ventilated subjects.

Keywords

• airway colonization,candida,mean platelet volume

References

1. 1. Murray JF, Nadel JA. Murray & Nadel's textbook of respiratory medicine: Elsevier Saunders; 2016.
2. 2. Pettenuzzo T, Fan E. 2016 Year in Review: Mechanical Ventilation. Respiratory care. 2017;62(5):629-35.
3. 3. Wunsch H, Linde-Zwirble WT, Angus DC, Hartman ME, Milbrandt EB, Kahn JM. The epidemiology of mechanical ventilation use in the United States. Critical care medicine. 2010;38(10):1947-53.
4. 4. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. Jama. 2002;287(3):345-55.
5. 5. Kumamoto CA, Vinces MD. Alternative Candida albicans lifestyles: growth on surfaces. Annual review of microbiology. 2005;59:113-33.
6. 6. Meersseman W, Lagrou K, Spriet I, Maertens J, Verbeken E, Peetermans WE, et al. Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study. Intensive Care Med. 2009;35(9):1526-31.
7. 7. Huang D, Qi M, Hu Y, Yu M, Liang Z. The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: A systematic review and meta-analysis. American journal of infection control. 2019.
8. 8. Tan X, Zhu S, Yan D, Chen W, Chen R, Zou J, et al. Candida spp. airway colonization: A potential risk factor for Acinetobacter baumannii ventilator-associated pneumonia. Medical mycology. 2016;54(6):557-66.

9. 9. Hamet M, Pavon A, Dalle F, Pechinot A, Prin S, Quenot JP, et al. Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia. Intensive Care Med. 2012;38(8):1272-9.
10. 10. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867-903.
11. 11. Timsit JF, Azoulay E, Schwebel C, Charles PE, Cornet M, Souweine B, et al. Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial. Jama. 2016;316(15):1555-64.
12. 12. Delisle MS, Williamson DR, Albert M, Perreault MM, Jiang X, Day AG, et al. Impact of Candida species on clinical outcomes in patients with suspected ventilator-associated pneumonia. Canadian respiratory journal. 2011;18(3):131-6.
13. 13. Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, et al. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest. 2006;129(1):110-7.
14. 14. Nseir S, Jozefowicz E, Cavestri B, Sendid B, Di Pompeo C, Dewavrin F, et al. Impact of antifungal treatment on Candida-Pseudomonas interaction: a preliminary retrospective case-control study. Intensive Care Med. 2007;33(1):137-42.
15. 15. Delisle MS, Williamson DR, Perreault MM, Albert M, Jiang X, Heyland DK. The clinical significance of Candida colonization of respiratory tract secretions in critically ill patients. J Crit Care. 2008;23(1):11-7.
16. 16. Heyland D, Jiang X, Day AG, Laverdiere M. Serum beta-d-glucan of critically ill patients with suspected ventilator-associated pneumonia: preliminary observations. J Crit Care. 2011;26(5):536.e1-.e9.
17. 17. Albert M, Williamson D, Muscedere J, Lauzier F, Rotstein C, Kanji S, et al. Candida in the respiratory tract secretions of critically ill patients and the impact of antifungal treatment: a randomized placebo controlled pilot trial (CANTREAT study). Intensive Care Med. 2014;40(9):1313-22.