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Antibiotic patterns associated with fungal colonization in critically ill surgical patients
L F D'Amelio1, B Wagner, S Azimuddin
1College of Pharmacy, Rutgers University, New Jersey, USA.
Abstract:
Fungal infections (FI) in surgical patients are increasing; mortality approaches 50 per cent. Prior studies identified factors predicting fungal colonization (FC) including broad spectrum antibiotics (BSA). This study investigates antibiotic patterns predicting FC. Other risk factors and outcomes are analyzed. A total of 72 consecutive SICU patients receiving > or = 7 days BSA were followed. None received prophylactic antifungals. Input data: Age, APACHE II, surgical procedure, lines, ulcer prophylaxis, TPN duration, antibiotic/antifungal regimen. Outcome data: FC, FI, length of SICU and hospital stay, mortality. A total of 32 patients (44%) developed FC; five (16%) developed FI (P = 0.08). All infected patients died (P = 0.0002). FC of GU (25%), respiratory (19%), and GI (19%) tracts were common. Multiple site colonization occurred in 25 per cent of colonized patients. Metronidazole and duration of ventilation predicted FC. APACHE II and TPN duration predicted mortality. Mortality occurred exclusively among patients requiring systemic antifungals. Among BSA, only metronidazole independently predisposed to FC. Other predictors of colonization and mortality agree with prior studies. The high mortality among patients requiring systemic antifungals implies that a more aggressive approach to prophylaxis may be warranted.
Insights
Metronidazole use in surgical intensive care unit (SICU) patients receiving broad-spectrum antibiotics (BSA) significantly predicted fungal colonization (FC). This colonization increased mortality risk, suggesting a need for targeted antifungal prophylaxis.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Fungal infections (FI) pose a significant threat to surgical patients, with high mortality rates.
- Broad-spectrum antibiotics (BSA) are known risk factors for fungal colonization (FC).
- Understanding specific antibiotic patterns predicting FC is crucial for patient management.
Purpose of the Study:
- To investigate antibiotic patterns that predict fungal colonization (FC) in surgical intensive care unit (SICU) patients.
- To analyze other risk factors and outcomes associated with FC and FI.
- To evaluate the impact of BSA, particularly metronidazole, on FC.
Main Methods:
- A cohort of 72 SICU patients receiving >= 7 days of BSA were studied prospectively.
- Data collected included patient demographics, clinical factors, and antibiotic/antifungal regimens.
- Outcomes assessed were FC, FI, length of stay, and mortality.
Main Results:
- 44% of patients developed FC; 16% developed FI, with all infected patients dying.
- Metronidazole and duration of mechanical ventilation were independent predictors of FC.
- APACHE II score and TPN duration predicted mortality.
Conclusions:
- Metronidazole was the only BSA that independently predisposed to FC in this cohort.
- High mortality among patients requiring systemic antifungals suggests a potential benefit from aggressive antifungal prophylaxis.
- Further research into prophylactic strategies for high-risk surgical patients is warranted.