The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants
The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants
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DOI：
10.1542/peds.2005-2677
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发表时间：
2006-08-01
期刊：
影响因子：
8
通讯作者：
Benjamin, Daniel K., Jr.
中科院分区：
文献类型：
--
作者：
Cotten, C. Michael;McDonald, Scott;Benjamin, Daniel K., Jr.
目标。先前的研究表明，不同中心的侵袭性念珠菌病发病率差异很大，并且先前使用广谱抗生素是极低出生体重婴儿发生念珠菌病的危险因素。中心实践的差异，例如抗生素策略以及这些策略对中心念珠菌病发病率的影响，并未反映在对个人念珠菌病风险的评估中。我们评估了极低出生体重婴儿的经验性抗生素实践与中心念珠菌病发病率之间的关系。方法。我们研究了一组极低出生体重婴儿，这些婴儿存活了 >= 72 小时，并在 1998 年至 2001 年间入住 12 个三级中心之一。使用多变量逻辑回归来验证之前使用广谱抗生素是个别婴儿随后患念珠菌病的危险因素。我们计算了相关系数来评估中心念珠菌病发病率与抗生素使用模式之间的关系。结果。来自 12 个中心的 3702 名婴儿中有 284 名（7.7%）患有侵袭性念珠菌病。广谱抗生素的使用与个别婴儿的念珠菌病有关。中心念珠菌病发病率为 2.4% 至 20.4%。中心念珠菌病的发病率与每个婴儿的平均广谱抗生素使用量以及每个婴儿培养阴性的广谱抗生素的平均使用量相关。结论。各中心侵袭性念珠菌病的发病率差异很大，抗生素使用方法的差异可能是导致中心念珠菌病风险差异的原因。
OBJECTIVES. Previous studies have shown that incidence of invasive candidiasis varies substantially among centers, and previous use of broad-spectrum antibiotics is a risk factor for candidiasis in extremely low birth-weight infants. Differences in center practices, such as antibiotic strategies and the effects of these strategies on center incidence of candidiasis, are not reflected in assessments of an individual's risk of candidiasis. We evaluated the relationship between empirical antibiotic practices for extremely low birth-weight infants and center incidence of candidiasis.METHODS. We studied a cohort of extremely low birth-weight infants who survived >= 72 hours and were admitted to 1 of 12 tertiary centers between 1998 and 2001. Multivariable logistic regression was used to validate previous broad-spectrum antibiotics use as a risk factor for subsequent candidiasis in individual infants. We calculated correlation coefficients to assess the relationship between center incidence of candidiasis with antibiotic practice patterns.RESULTS. There were 3702 infants from 12 centers included, and 284 (7.7%) developed invasive candidiasis. Broad-spectrum antibiotics use was associated with candidiasis for individual infants. Center candidiasis incidence ranged from 2.4% to 20.4%. Center incidence of candidiasis was correlated with average broadspectrum antibiotics use per infant and average use of broad-spectrum antibiotics with negative cultures per infant.CONCLUSIONS. Center incidences of invasive candidiasis differ substantially, and antibiotic practice differences are possible contributors to center variation in candidiasis risk.