ICU Patients' Antibiotic Exposure and Triazole-Resistance in Invasive Candidiasis: Parallel Analysis of Aggregated and Individual Data.
ICU Patients' Antibiotic Exposure and Triazole-Resistance in Invasive Candidiasis: Parallel Analysis of Aggregated and Individual Data.
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侵袭性念珠菌病中 ICU 患者的抗生素暴露和三唑耐药性：汇总数据和个体数据的并行分析
DOI：
10.3389/fphar.2021.586893
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发表时间：
2021
影响因子：
5.6
通讯作者：
Dong Y
中科院分区：
文献类型：
--
作者：
Wang Y;Zhang Y;McGuire TM;Hollingworth SA;Van Driel ML;Cao L;Wang X;Dong Y
背景：抗生素使用与抗侵袭性念珠菌病（IC）的抗生素使用率之间的关系尚不清楚。
方法：进行了回顾性多中心观测分析，以研究抗生素的暴露和candida spp的非降解临床分离株的入射。 （时间序列分析）和个人患者级（回归分析和可靠性评分调整）。
结果：393个鉴定出388名重症患者的念珠菌，有三种识别的表型：氟康唑抗性（FR，63，16.0％）在氟康唑和沃里基诺唑之间（CR，32，8.1％）。 （主要是头孢苯二酮/磺甲酰胺和头孢曲松），但没有三甲唑，对随后的ICU获得的抗三合中唑的IC具有直接的影响（时间滞后= 0）（P <0.05）。在个人患者级别上，我们发现接触许多抗真菌药物与三唑抗性显着相关（氟康唑[调整后的优势比（AOR）= 2.73]或与单三唑抗性的表型相比，在FR上的Caspofungin [AOR = 11.32]，voriconazole [AOR = 2.87]。
结论：抗生素 - 抗性抗性关系的群体级别和个人患者级别的分析产生了抗抗菌活性的明显但有价值的结果。 。
Background: The relationship between antibiotic use and the incidence of triazole-resistant phenotypes of invasive candidiasis (IC) in critically ill patients is unclear. Different methodologies on determining this relationship may yield different results. Methods: A retrospective multicenter observational analysis was conducted to investigate exposure to antibiotics and the incidence of non-duplicate clinical isolates of Candida spp. resistant to fluconazole, voriconazole, or both during November 2013 to April 2018, using two different methodologies: group-level (time-series analysis) and individual-patient-level (regression analysis and propensity-score adjusting). Results: Of 393 identified Candida spp. from 388 critically ill patients, there were three phenotypes of IC identified: fluconazole-resistance (FR, 63, 16.0%); voriconazole-resistance (VR, 46, 11.7%); and cross-resistance between fluconazole and voriconazole (CR, 32, 8.1%). Exposure to several antibacterial agents with activity against the anaerobic gastrointestinal flora, especially third-generation cefalosporins (mainly cefoperazone/sulbactam and ceftriaxone), but not triazoles, have an immediate effect (time lag = 0) on subsequent ICU-acquired triazole-resistant IC in the group-level (p < 0.05). When the same patient database was analyzed at the individual-patient-level, we found that exposure to many antifungal agents was significantly associated with triazole-resistance (fluconazole [adjusted odds ratio (aOR) = 2.73] or caspofungin [aOR = 11.32] on FR, voriconazole [aOR = 2.87] on CR). Compared to the mono-triazole-resistant phenotype, CR IC has worse clinical outcomes (14-days mortality) and a higher level of resistance. Conclusion: Group-level and individual-patient-level analyses of antibiotic-use-versus-resistance relations yielded distinct but valuable results. Antibacterials with antianaerobic activity and antifungals might have “indirect” and “direct” effect on triazole-resistant IC, respectively.
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影响因子：
5.2
作者：
Vernaz, Nathalie;Huttner, Benedikt;Harbarth, Stephan
通讯作者：
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影响因子：
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