Antibiotic Exposure as a Risk Factor for Fluconazole-Resistant Candida Bloodstream Infection
Antibiotic Exposure as a Risk Factor for Fluconazole-Resistant Candida Bloodstream Infection
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DOI：
10.1128/aac.05947-11
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发表时间：
2012-05-01
影响因子：
4.9
通讯作者：
Giladi, Michael
中科院分区：
文献类型：
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作者：
Ben-Ami, Ronen;Olshtain-Pops, Keren;Giladi, Michael
近期接触唑类药物是感染氟康唑耐药念珠菌的重要危险因素，但关于抗菌药物暴露在耐药念珠菌出现中的作用知之甚少。我们在以色列进行了一项前瞻性的全国性念珠菌血症监测研究，并分析了抗真菌和抗细菌药物暴露与血流感染念珠菌之间的倾向评分调整相关性。光滑念珠菌和氟康唑耐药念珠菌分离株。444例念珠菌血症（450例念珠菌分离株，69例[15%] C。包括来自以色列18个医学中心的38个[8.5%]氟康唑耐药菌株。C. glabrata血流感染与近期接触甲硝唑密切相关（优势比[OR]，3.2; P < 0.001）。氟康唑耐药分离株感染与碳青霉烯类、复方新诺明、克林霉素和粘菌素暴露相关（比值比，2.8; P = 0.01）。在多变量模型中纳入抗菌药物暴露显著提高了模型对氟康唑耐药念珠菌血流感染的预测准确性。我们的研究结果可能与经验性抗真菌治疗的选择有关，并扩大了抗真菌相关的附带损害的范围。
Recent exposure to azoles is an important risk factor for infection with fluconazole-resistant Candida spp., but little is known about the role of antibacterial drug exposure in the emergence of drug-resistant Candida. We did a prospective nationwide surveillance study of candidemia in Israel and analyzed the propensity score-adjusted association between antifungal and antibacterial drug exposure and bloodstream infection with C. glabrata and fluconazole-resistant Candida isolates. Four hundred forty-four episodes of candidemia (450 Candida isolates, 69 [15%] C. glabrata isolates, and 38 [8.5%] fluconazole-resistant isolates) from 18 medical centers in Israel were included. C. glabrata bloodstream infection was strongly associated with recent metronidazole exposure (odds ratio [OR], 3.2; P < 0.001). Infection with a fluconazole-resistant isolate was associated with exposure to carbapenems, trimethoprim-sulfamethoxazole, clindamycin, and colistin (odds ratio, 2.8; P = 0.01). The inclusion of antibacterial drug exposure in a multivariable model significantly enhanced the model's predictive accuracy for fluconazole-resistant Candida bloodstream infection. Our findings may be relevant to the selection of empirical antifungal treatment and broaden the scope of antibiotic-associated collateral damage.