The Presence of Candida in Bronchoalveolar Lavage Specimens in Immunocompromised Patients

K. Trevino, T. Davis

Author address: 

Indiana Univ., Indianapolis, IN

Abstract: 

The presence of Candida in bronchoalveolar lavage (BAL) specimens is both common and commonly ignored due to its association with oral contamination. Invasive candiasis has an incidence of 10-14 per 100,000 individuals and an even higher incidence in immunocompromised patients. Whether the presence of Candida in a BAL specimen is significant in an immunocompromised patient population is unknown, leaving clinicians to interpret this reported finding based on the clinical scenario.Infectious disease pathology consults performed at Indiana University were reviewed from 2013-2015. 139 cases had yeast consistent with Candida in their BAL specimens. 124 of the cases underwent chart review, and culture, antigen testing, treatment, and outcomes data were collected for the 4 weeks surrounding the consult. The cases were sorted based on the presence or lack of treatment with an antifungal and the reason for treatment. Data was analyzed using chi square to assess the significance of outcome differences among those treated and those not treated for candidiasis.5 of 124 cases reviewed demonstrated invasive candidiasis by blood culture. None of these cases had corresponding antigen testing performed. 8 other cases had positive antigen testing but blood cultures remained negative. Overall, 61 of the 124 patients received treatment with an antifungal. 51 of the 124 patients had a poor outcome (death or discharged to hospice). There was no significant difference in outcome between patients who were treated with an antifungal and those who were not (poor outcomes in 28/61 and 23/63 patients respectively). There was also no significant difference in outcomes between groups based on the reason for treatment.Incidence of invasive candiasis in this population was higher than the general population (4% vs. 0.014%). However, we did not compare this rate to an immunocompromised population that did not demonstrate Candida in their BAL specimens. This further study is needed to assess whether this incidence is higher than a similarly immunocompromised population without the presence of Candida in their BAL. Nearly 50% of patients were treated with an antifungal during their hospitalization, with 12% treated solely based on their BAL result. However, no difference was seen in the overall outcome of the patients based on this treatment.
2016

abstract No: 

SATURDAY-306

Full conference title: 

ASM Microbe 2016
    • ASM microbe 1st (2016)