title: Analysis of the relationship between fluconazole consumption and non-C. albicans Candida infections.
abstract: The effect of fluconazole consumption on the incidence of nosocomial non-C. albicans Candida infections remains unclear. In this study we investigated such a relationship in an intensive care unit (Poland) over an 11-year period (2002-2012). Statistics relating to the number of candidiasis cases and the number of defined daily doses of fluconazole showed that only a very weak and not statistically significant linear correlation existed between these two variables (r(2) = 0.36, P = 0.052). However, the assumption of a 1-year delay in the infection response to changes in fluconazole concentrations resulted in a strong and statistically significant linear correlation (r(2) = 0.64, P = 0.0053). To more accurately determine the nature of this relationship, a simple epidemiological model was proposed that provided a better than linear correlation (r(2) = 0.78, P = 0.00077). We successfully used this approach to analyze results from the literature that were interpreted as evidence that fluconazole use is not a risk factor for development of non-C. albicans Candida infections. If a time delay in the infection response was assumed, a strong and statistically significant correlation was obtained. These findings suggest the need for a closer look at fluconazole therapy as a possible risk factor for development of non-C. albicans Candida infections.
authors.affiliation: Department of Environmental Biology, Medical University of Lodz, Poland Department of Microbiology, Lodz Medical University Hospital No. 1, Poland ewa.tyczkowska-sieron@umed.lodz.pl jatyczko@wipos.p.lodz.pl.
authors.forename: E
authors.initials: E
authors.lastname: Tyczkowska-Sieron
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Lodz Medical University Hospital No. 1, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Gaszynski
authors.affiliation: Department of Molecular Engineering, Lodz University of Technology, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Tyczkowski
authors.affiliation: Department of Environmental Biology, Medical University of Lodz, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Glowacka
mesh_terms: D000328:Adult; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D015233:Models, Statistical; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D015725:Fluconazole
keywords: Candida albicans; fluconazole; non–C. albicans Candida; nosocomial candidiasis