Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection.
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.
Tel Aviv Sourasky Medical Center, Tel Aviv. ronenba@tasmc.health.gov.il
Ronen
R
Ben-Ami
Keren
K
Olshtain-Pops
Michal
M
Krieger
Ilana
I
Oren
Jihad
J
Bishara
Michael
M
Dan
Yonit
Y
Wiener-Well
Miriam
M
Weinberger
Oren
O
Zimhony
Michal
M
Chowers
Gabriel
G
Weber
Israel
I
Potasman
Bibiana
B
Chazan
Imad
I
Kassis
Itamar
I
Shalit
Colin
C
Block
Nathan
N
Keller
Dimitrios P
DP
Kontoyiannis
Michael
M
Giladi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000254:growth & development; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D041221:Candida glabrata / Q000187:drug effects* / Q000502:physiology; D058387:Candidemia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D015780:Carbapenems / Q000008:administration & dosage / Q000009:adverse effects; D002981:Clindamycin / Q000008:administration & dosage / Q000009:adverse effects; D060085:Coinfection; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007557:Israel; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D015780:Carbapenems; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015725:Fluconazole; D003091:Colistin