Relationship of fluconazole prophylaxis with fungal microbiology in hospitalized intra-abdominal surgery patients: a descriptive cohort study.
Relationship of fluconazole prophylaxis with fungal microbiology in hospitalized intra-abdominal surgery patients: a descriptive cohort study.
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氟康唑预防与住院治疗的腹腔手术患者中真菌微生物学的关系：一项描述性队列研究。
DOI：
10.1186/s13054-014-0590-1
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发表时间：
2014-10-29
期刊：
影响因子：
--
通讯作者：
Shorr AF
中科院分区：
文献类型：
--
作者：
Zilberberg M;Yu HT;Chaudhari P;Emons MF;Khandelwal N;Shorr AF
从历史上看，白色念珠菌是念珠菌血症最常见的原因。然而，由于非白色念珠菌属的血液感染的比例有所增加。由于腹腔手术患者存在念珠菌血症的风险，一些专家提倡使用氟康唑预防。这种做法对该人群中突破性真菌感染中分离的念珠菌属分布的影响尚不清楚。我们研究了腹腔手术患者中氟康唑预防与念珠菌属分布的关系。我们回顾性地确定了2005年7月至2012年10月期间住院成人腹腔内手术患者中念珠菌血培养（BCx）阳性的病例。分离的念珠菌属分布代表我们的主要终点。根据出院国际疾病分类第九版临床修订版（ICD-9-CM）代码的审查确定合格的手术病例。在BCx阳性之前接受低剂量氟康唑治疗且已知预防性适应症（包括中性粒细胞减少症、ICU暴露或器官移植史）的患者被归类为预防性治疗。真菌治疗的适宜性取决于真菌分离物的选择和抗真菌药物的选择。在10，839例腹腔内手术患者中，227例患有念珠菌血症。最常见的念珠菌是C.白色念珠菌90例，占39.6%; glabrata（n = 81，35.7%）和C.近平滑（n = 38，16.7%）。非白色念珠菌占57.7%的194名非预防性患者和75.8%的33名预防性患者（P = 0.001）。C. glabrata，最常见的非C.白色念珠菌的检出率高于念珠菌。白色念珠菌的人给予预防，但不是在那些没有预防。共有63%的念珠菌血症患者根据抗真菌药物给药的时机和选择进行了不适当的治疗。在高危手术患者中，氟康唑预防治疗的选择压力可能与随后的念珠菌血症向氟康唑耐药菌漂移有关。需要通过及时识别和表征念珠菌血症来指导适当治疗的工具。本文的在线版本（doi：10.1186/s13054-014-0590-1）包含补充材料，可供授权用户使用。
Historically, Candida albicans has represented the most common cause of candidemia. However, the proportion of bloodstream infections due to non-albicans Candida species has increased. Because of the risk for candidemia in intra-abdominal surgical patients, some experts advocate the use of fluconazole prophylaxis. The impact of this practice on the distribution of Candida species isolated in breakthrough fungal infections in this population is unknown. We examined the association of fluconazole prophylaxis with the distribution of Candida species in intra-abdominal surgery patients. We retrospectively identified cases with a positive blood culture (BCx) for Candida among hospitalized adult intra-abdominal surgery patients between July 2005 and October 2012. Distribution of Candida species isolated represented our primary endpoint. Qualifying surgical cases were determined based on a review of discharge International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients receiving low-dose fluconazole prior to the positive BCx with a known indication for prophylaxis including neutropenia, ICU exposure or history of organ transplantation were classified as prophylaxis. Appropriateness of fungal treatment was determined by the timing and selection of antifungal agent based on fungal isolate. Among 10,839 intra-abdominal surgery patients, 227 had candidemia. The most common Candida species isolated was C. albicans (n = 90, 39.6%) followed by C. glabrata (n = 81, 35.7%) and C. parapsilosis (n = 38, 16.7%). Non-albicans Candida accounted for 57.7% of isolates among the 194 non-prophylaxis patients and 75.8% among the 33 prophylaxis patients (P = 0.001). C. glabrata, the most common non-C. albicans species, was more prevalent than C. albicans in persons given prophylaxis, but not in those without prophylaxis. A total of 63% of those with candidemia were treated inappropriately based on the timing and selection of antifungal administration. Selection pressure from fluconazole prophylaxis in at-risk surgical patients may be associated with a drift toward fluconazole-resistant species in subsequent candidemia. Tools are needed to guide appropriate treatment through the prompt recognition and characterization of candidemia. The online version of this article (doi:10.1186/s13054-014-0590-1) contains supplementary material, which is available to authorized users.
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影响因子：
11.8
作者：
Horn, David L.;Neofytos, Dionissios;Webster, Karen M.
通讯作者：
Webster, Karen M.
影响因子：
11.8
作者：
Nucci, M;Anaissie, E
通讯作者：
Anaissie, E
影响因子：
5.2
作者：
Playford, EG;Webster, AC;Craig, JC
通讯作者：
Craig, JC
影响因子：
11.8
作者：
Zaoutis, TE;Argon, J;Feudtner, C
通讯作者：
Feudtner, C
影响因子：
11.8
作者：
Garey, Kevin W.;Rege, Milind;Bearden, David T.
通讯作者：
Bearden, David T.