trimethoprim--sulfamethoxazole-drug-combination and Candidemia

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.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antifungal Agents; Bacteria; Bacterial Infections; Candida glabrata; Candidemia; Candidiasis; Carbapenems; Clindamycin; Coinfection; Colistin; Drug Resistance, Fungal; Female; Fluconazole; Humans; Israel; Microbial Sensitivity Tests; Middle Aged; Odds Ratio; Prospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination