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.
Publication types
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Multicenter Study
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Aged
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Aged, 80 and over
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Anti-Bacterial Agents / administration & dosage
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Anti-Bacterial Agents / adverse effects*
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Antifungal Agents / administration & dosage
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Antifungal Agents / therapeutic use
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Bacteria / drug effects
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Bacteria / growth & development
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Bacterial Infections / drug therapy*
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Bacterial Infections / microbiology
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Candida glabrata / drug effects*
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Candida glabrata / physiology
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Candidemia / drug therapy*
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Candidemia / etiology
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Candidemia / microbiology
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Candidiasis / drug therapy*
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Candidiasis / etiology
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Candidiasis / microbiology
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Carbapenems / administration & dosage
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Carbapenems / adverse effects
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Clindamycin / administration & dosage
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Clindamycin / adverse effects
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Coinfection
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Colistin / administration & dosage
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Colistin / adverse effects
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Drug Resistance, Fungal
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Female
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Fluconazole / administration & dosage
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Fluconazole / therapeutic use*
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Humans
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Israel
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Microbial Sensitivity Tests
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Middle Aged
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Odds Ratio
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Prospective Studies
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Risk Factors
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Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
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Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects
Substances
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Anti-Bacterial Agents
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Antifungal Agents
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Carbapenems
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Clindamycin
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Trimethoprim, Sulfamethoxazole Drug Combination
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Fluconazole
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Colistin