Effect of fluconazole consumption on long-term trends in candidal ecology

被引:59
作者
Blot, S.
Janssens, R.
Claeys, G.
Hoste, E.
Buyle, F.
De Waele, J. J.
Peleman, R.
Vogelaers, D.
Vandewoude, K.
机构
[1] Ghent Univ Hosp, Dept Intens Care, B-9000 Ghent, Belgium
[2] Hogesch Gent Vesalius, Hlth Care Dept, B-9000 Ghent, Belgium
[3] Ghent Univ Hosp, Dept Microbiol, B-9000 Ghent, Belgium
[4] Ghent Univ Hosp, Dept Infect Dis, B-9000 Ghent, Belgium
关键词
Candida species; candidaemia; antifungals; nosocomial; exposure;
D O I
10.1093/jac/dkl241
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Fluconazole is an antifungal agent that is widely used for the treatment of Candida infection. Because of its favourable safety profile it is extensively used for prophylaxis in patient populations with a substantial risk for Candida infection. At the individual patient level, exposure to fluconazole selects for Candida non-albicans strains such as Candida glabrata and Candida krusei, with reduced susceptibility or intrinsic resistance to fluconazole. The effect of the volume of consumption of fluconazole on candidal ecology, however, is poorly investigated. Objectives: The long-term effect of fluconazole consumption on distribution of species causing candidaemia was investigated in a university hospital during an 11 year period (1994-2004). Methods: In a historical cohort the incidence of nosocomial candidaemia (expressed per 100 000 patient days) was linked with volume consumption of fluconazole [expressed as defined daily doses (DDDs) per 100 000 patient days] and evaluated over time. Results: During the study period 308 episodes of candidaemia occurred (63.3% caused by Candida albicans). The incidence of candidaemia varied from 6.0 to 13.8 per 100 000 patient days. The percentage candidaemia caused by Candida non-albicans spp. varied between 21% and 50%. No trends in the number of candidaemias or in the proportion of C. albicans versus Candida non-albicans spp. were observed. Fluconazole consumption was high but stable ranging from 5013 to 6807 DDDs per 100 000 patient days. No relationship could be demonstrated between volume of fluconazole consumption and Candida spp. distribution (Pearson's correlation coefficient: -0.083; P = 0.808). Conclusions: Despite long-term exposure to fluconazole, no change in candidal ecology was observed.
引用
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页码:474 / 477
页数:4
相关论文
共 10 条
[1]   Trends in antifungal use and epidemiology of nosocomial yeast infections in a university hospital [J].
Berrouane, YF ;
Herwaldt, LA ;
Pfaller, MA .
JOURNAL OF CLINICAL MICROBIOLOGY, 1999, 37 (03) :531-537
[2]   Management of invasive candidiasis in critically ill patients [J].
Blot, S ;
Vandewoude, K .
DRUGS, 2004, 64 (19) :2159-2175
[3]   Secular trends of candidemia over 12 years in adult patients at a tertiary care hospital [J].
Garbino, J ;
Kolarova, L ;
Rohner, P ;
Lew, D ;
Pichna, P ;
Pittet, D .
MEDICINE, 2002, 81 (06) :425-433
[4]  
HARTSTEIN AI, 1995, INFECT CONT HOSP EP, V16, P405
[5]   PREDOMINANT PATHOGENS IN HOSPITAL INFECTIONS [J].
JARVIS, WR ;
MARTONE, WJ .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1992, 29 :19-24
[6]   Epidemiology of candidemia in Swiss tertiary care hospitals:: Secular trends, 1991-2000 [J].
Marchetti, O ;
Bille, J ;
Fluckiger, U ;
Eggimann, P ;
Ruef, C ;
Garbino, J ;
Calandra, T ;
Glauser, MP ;
Täuber, MG ;
Pittet, D .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (03) :311-320
[7]  
Nguyen MH, 1996, AM J MED, V100, P617, DOI 10.1016/S0002-9343(95)00010-0
[8]   Shifting patterns in the epidemiology of nosocomial Candida infections [J].
Snydman, DR .
CHEST, 2003, 123 (05) :500S-503S
[9]   Surveillance of nosocomial transmission of Candida albicans in an intensive care unit by DNA fingerprinting [J].
Taylor, BN ;
Harrer, T ;
Pscheidl, E ;
Schweizer, A ;
Röllinghoff, M ;
Schröppel, K .
JOURNAL OF HOSPITAL INFECTION, 2003, 55 (04) :283-289
[10]   Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989-1999 [J].
Trick, WE ;
Fridkin, SK ;
Edwards, JR ;
Hajjeh, RA ;
Gaynes, RP .
CLINICAL INFECTIOUS DISEASES, 2002, 35 (05) :627-630