Candidemia in allogeneic blood and marrow transplant recipients: Evolution of risk factors after the adoption of prophylactic fluconazole
Candidemia in allogeneic blood and marrow transplant recipients: Evolution of risk factors after the adoption of prophylactic fluconazole
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DOI：
10.1086/315193
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发表时间：
2000-01-01
影响因子：
6.4
通讯作者：
Bowden, RA
中科院分区：
文献类型：
--
作者：
Marr, KA;Seidel, K;Bowden, RA
氟康唑的预防性使用在血液和骨髓移植（BMT）受者中很常见。为了评估氟康唑如何影响唑类药物耐药性和念珠菌血症的发展，每周进行漱口，并测定从接受BMT的患者中获得的1475株定植和侵袭性分离株的氟康唑敏感性。在585例患者中，256例（44%）在BMT过程中被念珠菌定植，其中，136名患者（53%）至少有1份漱口水样本产生了除念珠菌外的念珠菌。白色念珠菌培养。仅4.6%的患者发生念珠菌血症。白念珠菌是最常见的定植菌，但仅占念珠菌血症的7%。约5%的定植菌和100%（2/2）的侵袭性白念珠菌对氟康唑耐药。定植、巨细胞病毒病和菌血症是发生念珠菌血症的危险因素，尽管BMT受者中存在唑类耐药念珠菌定植，但预防性使用氟康唑与念珠菌血症的发生率和归因死亡率低相关。
The prophylactic use of fluconazole is common in blood and marrow transplant (BMT) recipients. To evaluate how fluconazole has influenced the development of azole resistance and candidemia, weekly mouthwashings were done, and fluconazole susceptibility was determined for 1475 colonizing and invasive isolates obtained from patients undergoing BMT, Of 585 patients, 256 (44%) were colonized with Candida species during the course of BMT, Of these, 136 patients (53%) had at least 1 mouthwashing sample that yielded Candida species other than C. albicans on culture. Only 4.6% of patients developed candidemia, Overall, C. albicans was the most common colonizing isolate, but it caused only 7% of cases of candidemia, About 5% of colonizing C, albicans strains and 100% (2 of 2) invasive C, albicans strains were fluconazole-resistant. Colonization, cytomegalovirus disease, and bacteremia are risk factors for the development of candidemia, The use of prophylactic fluconazole is associated with a low incidence of candidemia and attributable mortality, despite colonization with azole-resistant Candida species in BMT recipients.