Prior colonisation with Candida species fails to guide empirical therapy for candidaemia in critically ill adults.

Autor: Troughton JA; Department of Microbiology, Kelvin Laboratories, Royal Group Hospital Trust, Grosvenor Road, BT12 6BA, Belfast, UK. judith.troughton@belfasttrust.hscni.net, Browne G, McAuley DF, Walker MJ, Patterson CC, McMullan R
Jazyk: angličtina
Zdroj: The Journal of infection [J Infect] 2010 Nov; Vol. 61 (5), pp. 403-9. Date of Electronic Publication: 2010 Sep 16.
DOI: 10.1016/j.jinf.2010.08.013
Abstrakt: Objectives: Pre-emptive fluconazole (fcz) anti-fungal therapy is often based upon Candida colonisation of at least 2 non-contiguous non-sterile sites. The aim of this study was to evaluate the relationship between candidaemia and prior colonisation of non-sterile sites.
Methods: A retrospective observational study was performed in the intensive care unit/high dependency unit (ICU/HDU) of a University hospital on alternate years from 1999-2007, where a pre-emptive anti-fungal therapy policy was introduced in 2005.
Results: A higher proportion of blood isolates were Candida glabrata compared with non-sterile isolates (16/46 vs 106/1062; p < 0.001), similarly a greater proportion of blood isolates were fcz-resistant compared with non-sterile isolates (15/46 vs 101/1062; p < 0.001). No trend over time was detected in the proportion of C. glabrata and Candida albicans isolates from blood and non-sterile sites, or in the fcz-sensitivity of isolates from these sites. C. glabrata candidaemia was more likely to occur in the absence of non-sterile site colonisation compared with non-glabrata candidaemia (12/16 vs 8/30; p = 0.005). Of candidaemic patients, 43% had no preceding colonisation by any Candida spp.; in 67% of these patients, candidaemia was due to C. glabrata.
Conclusions: Pre-emptive therapy based upon colonisation of at least two sites may be inadequate as 43% of candidaemic patients had no evidence of prior colonisation, 67% of whom had candidaemia due to C. glabrata. Furthermore if pre-emptive anti-fungal therapy is instituted in non-colonised patients there is a risk of selecting an inappropriate anti-fungal for C. glabrata. Despite the introduction of pre-emptive fcz therapy, no time trend was detected in the proportion of fcz-sensitive isolates from blood and non-sterile sites.
(Copyright © 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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