Risk factors for breakthrough candidemia.
In order to assess the risk factors for breakthrough candidemia (candidemia occurring in patients receiving at least 3 days of systemic fluconazole or amphotericin B), 270 cases of candidemia occurring in two tertiary hospitals were analyzed. Using multivariate analysis, profound neutropenia (<100/mm(3)) (odds ratio [OR], 9.14), use of corticosteroids (OR, 3.17), and heavy antibiotic exposure (previous use of 2 or more antibiotics for at least 14 days) (OR, 2.93) were identified as risk factors. Neither the susceptibility of the isolates nor the presence of a catheter was found to be a risk factor. These data suggest that gastrointestinal colonization plays a major role in the development of breakthrough candidemia.
Nucci
M
M
University Hospital, Universidade Federal do Rio de Janeiro, Avenida Brigadeiro Trompovsky, s/n 21941-590, Rio de Janeiro, Brazil. mnucci@hucff.ufrj.br
Colombo
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D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D015725:Fluconazole