This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (32)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Surgery, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Analysis of Bacterial and Fungal Resistance

Thomas R. Rocco, MD; Steven E. Reinert, MS; H. Hank Simms, MD

Arch Surg. 2000;135:160-165.

Hypothesis  The administration of fluconazole in intensive care unit (ICU) patients leads to the emergence of bacterial and fungal resistance.

Design  Retrospective analysis of 2 patient cohorts: (1) critically ill patients treated in surgical, trauma, and medical ICUs between June 1997 and January 1999 who did and did not receive fluconazole; and (2) ICU patients with fungal infections and sensitivity testing results from June 1994 to December 1998.

Setting  University-affiliated tertiary care hospital.

Patients  The first cohort included 99 ICU patients with documented microorganism culture(s) who were treated with (n = 50) or without (n = 49) fluconazole; the second cohort included 38 patients with Candida species infection, identification, and antifungal susceptibility testing.

Results  Mortality (40% vs 20%; P = .03) and hospital length of stay (33.8 vs 25.6 days; P = .04) were higher in the patients treated with fluconazole compared with patients not treated with fluconazole. The ICU length of stay was also higher in patients treated with fluconazole (23.7 vs 15.1 days; P = .009). An increase in bacterial resistance occurred in patients after fluconazole treatment as opposed to bacterial resistance of patients who were treated for bacterial microorganism(s) without fluconazole (16% vs 4%; P = .049). Comparison of patient populations with Candida species identification before and after December 1997 showed an increase in Candida species resistance to fluconazole (11% vs 36%; P = .16), respectively. Fungal strains were dominated by a combination of Candida albicans and Candida glabrata in both populations (60% [before 1998] vs 82% [after 1998]), with an emergence of Candida non-albicans species tolerant to fluconazole. The amount of fluconazole administered and the number of patients receiving fluconazole treatment in the ICUs has also increased when comparing both periods.

Conclusions  Comparison of critically ill patient populations with and without fluconazole treatment found increased mortality and longer hospital and ICU lengths of stay in the fluconazole-treated group. This group also had higher bacterial pathogen resistance to antibiotics after fluconazole administration compared with bacterial resistance of patients without fluconazole treatment. Our results warrant concern regarding worsening bacterial infections, increased mortality, and an increase in Candida resistance to fluconazole from increased use in ICU patients, with a shift in yeast infection that is more difficult to treat.

From the Department of Surgery, Brown University, and Division of Surgical Critical Care, Rhode Island Hospital (Drs Rocco and Simms), and Center for Statistical Sciences, Brown University (Mr Reinert), Providence, RI.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2000;135(2):241-242.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Inhibition of Fungal {beta}-1,3-Glucan Synthase and Cell Growth by HM-1 Killer Toxin Single-Chain Anti-Idiotypic Antibodies.
Selvakumar et al.
Antimicrob. Agents Chemother. 2006;50:3090-3097.
ABSTRACT | FULL TEXT  

Fluconazole for the management of invasive candidiasis: where do we stand after 15 years?
Charlier et al.
J Antimicrob Chemother 2006;57:384-410.
ABSTRACT | FULL TEXT  

Susceptibility of Candida dubliniensis to Salivary Histatin 3
Fitzgerald et al.
Antimicrob. Agents Chemother. 2003;47:70-76.
ABSTRACT | FULL TEXT  

Increasing Incidence of Candidemia: Results from a 20-Year Nationwide Study in Iceland
Asmundsdottir et al.
J. Clin. Microbiol. 2002;40:3489-3492.
ABSTRACT | FULL TEXT  

Rapid Identification of Candida Species by Confocal Raman Microspectroscopy
Maquelin et al.
J. Clin. Microbiol. 2002;40:594-600.
ABSTRACT | FULL TEXT  

Inadequate Proof of Adverse Outcome Due to the Use of Fluconazole in Critically Ill Patients
Blot et al.
Arch Surg 2000;135:1114-1114.
FULL TEXT