Candida Host Defense Response After Septic Shock in the Critically Ill

Study Overview
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Brief Summary
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Septic shock is associated with acquired immunoparalysis which is associated with a high risk of nosocomial acquired infection. Nosocomial candidiasis is associated with a 50% rate of mortality but is difficult to diagnose. The use of colonization indexes and risk factors on the other hand expose to unnecessary use of antifungals. The aim of the present study is to evaluate whether the host response to infection associated with candida biomarkers would help to anticipate the candidiasis onset.

Detailed Description
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Single center prospective observationnal study. Inclusion: all consecutive patients subsequently to a septic shock with no Candida infection. Measured parameters: host response (HLADR, CD64, inflammatory cytokines consecutive to LPS exposition) and Candida biomarkers (beta D Glucan, Mannan Ag and Ig), demographics, outcome (occurence of Candida nosocomial infection, morbidity and survival)

Official Title
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IMMUNOCANDIDA Candida Host Defense Response After Septic Shock in the Critically Ill

Conditions
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Septic Shock, Candidiasis

Intervention / Treatment
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* Diagnostic Test: Candidiasis infection occurence


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > = 18 years The patients in toxic shock defined according to the Bone criteria Informed consent of the patient or his reliable person (poursuit consent in this case). Possibility of inclusion according to the emergency procedure with the obligation of research for the consent with the reliable person and with the patient. Obligation of membership or beneficiary to have a national insurance Exclusion Criteria: Pregnant or breast-feeding women according to the article L1121-5 of the CSP Vulnerable people according to the article L1121-6 of the CSP 9358 _  Neutropénie 500 / mm3 Infection by the HIV, the hepatitis C or B active column Biotherapics (anti-CD20, anti-TNFa, anti-IL-6) Treatments immunosuppresseurs (methotrexate, azathioprine, cyclophosphamide, mycophenolate mofétil, cyclosporine, tacrolimus) Corticosteroid therapy = 1mg / kg of equivalent prednisone for more than a month Toxic shock due to a deep candidiasis in the admission in resuscitation Congenital deficits of Th17 (cutanéo-mucous candidiasis chronicles, syndrome of hyper IgE)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Septic shock and candidiasis<br>The realized analyses will be two types: 1/an immunological analysis that is the characterization of the capacities of defense against germs and 2/a search(research) of Candida by microscopic examination and culture on circles of growth but also the research for the genome of the mushroom by a state-of-the-art technique of the laboratory of mycology ( PCR). Usual takings of research for bacteria. | Diagnostic Test: Candidiasis infection occurence<br>* Candidiasis infection occurence<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Candidiasis infection occurence | Outcome | Day 28 survival | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Septic shock, Candidiasis, Candidemia, Bacteremia, Immunoparalysis