Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection.

Abstract

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.

• Authors: Ronen Ben-Ami, Keren Olshtain-Pops, Michal Krieger, Ilana Oren, Jihad Bishara, Michael Dan, Yonit Wiener-Well, Miriam Weinberger, Oren Zimhony, Michal Chowers, Gabriel Weber, Israel Potasman, Bibiana Chazan, Imad Kassis, Itamar Shalit, Colin Block, Nathan Keller, Dimitrios P Kontoyiannis, Michael Giladi, Israeli Candidemia Study Group
• Journal: Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 56 Issue 5 Pg. 2518-23 (May 2012) ISSN: 1098-6596 [Electronic] United States
• PMID: 22314534 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Antifungal Agents
• Carbapenems
• Clindamycin
• Trimethoprim, Sulfamethoxazole Drug Combination
• Fluconazole
• Colistin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage, adverse effects)
• Antifungal Agents (administration & dosage, therapeutic use)
• Bacteria (drug effects, growth & development)
• Bacterial Infections (drug therapy, microbiology)
• Candida glabrata (drug effects, physiology)
• Candidemia (drug therapy, etiology, microbiology)
• Candidiasis (drug therapy, etiology, microbiology)
• Carbapenems (administration & dosage, adverse effects)
• Clindamycin (administration & dosage, adverse effects)
• Coinfection
• Colistin (administration & dosage, adverse effects)
• Drug Resistance, Fungal
• Female
• Fluconazole (administration & dosage, therapeutic use)
• Humans
• Israel
• Microbial Sensitivity Tests
• Middle Aged
• Odds Ratio
• Prospective Studies
• Risk Factors
• Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage, adverse effects)