Department of Medicine, Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Gray-Jackson 504, 55 Fruit St, Boston, MA 02114, USA.
Mycopathologia. 2011 Feb;171(2):85-91. doi: 10.1007/s11046-010-9369-3. Epub 2010 Oct 8.
Fluconazole is the first line of therapy for the management of candidiasis. However, fluconazole-resistant strains pose an emerging challenge in everyday clinical practice. In this study, we sought to determine whether cumulative length of hospital stay (CLOS) is a predictive factor for the acquisition of non-susceptible Candida strains to fluconazole. Thirty-three critically ill emergency surgery patients with 56 Candida isolates were enrolled in this prospective study. We divided our isolates according to their minimum inhibitory concentration (MIC) to fluconazole using 8 mcg/ml as a cutoff. We then compared the two groups with respect to basic demographics, antifungal agents prescribed, number of wide-spectrum antibiotics, duration of central venous catheter placement, elapsed time to positive culture, duration of prior hospital stay, and length of hospital stay. Non-susceptible fluconazole samples belonged to patients with a significantly longer prior hospital stay and a longer CLOS (P = 0.02 and 0.01, respectively). The difference between the 2 groups regarding non-albicans strains was statistically significant (P < 0.001). By fitting a non-parametric receiver-operating characteristics (ROC) curve into our analysis, a CLOS ≥ 29 days predicted the occurrence of non-susceptible strains with 90% sensitivity and 79.6% specificity (correct classification 81.5%). A CLOS ≥ 29 days is a strong predictor for the isolation of non-susceptible Candida isolates to fluconazole among critically ill emergency surgery patients. Clinicians should consider the duration of previous hospital stay when deciding on empiric antifungal therapy.
氟康唑是治疗念珠菌病的一线治疗药物。然而，氟康唑耐药株在日常临床实践中构成了一个新出现的挑战。在这项研究中，我们试图确定住院时间（CLOS）是否是获得对氟康唑不敏感的念珠菌株的预测因素。这项前瞻性研究纳入了 33 名患有 56 株念珠菌分离株的重症急救手术患者。我们根据最低抑菌浓度（MIC）将我们的分离株分为氟康唑 8μg/ml 作为临界值。然后，我们比较了两组患者的基本人口统计学数据、抗真菌药物的使用、广谱抗生素的数量、中心静脉导管放置时间、阳性培养的时间、先前住院时间和住院时间。非敏感氟康唑样本来自先前住院时间和 CLOS 较长的患者（P=0.02 和 0.01）。两组之间关于非白色念珠菌菌株的差异具有统计学意义（P<0.001）。通过将非参数接收器操作特性（ROC）曲线拟合到我们的分析中，CLOS≥29 天可预测非敏感菌株的发生，敏感性为 90%，特异性为 79.6%（正确分类 81.5%）。CLOS≥29 天是重症急救手术患者中分离出对氟康唑不敏感的念珠菌株的有力预测因素。临床医生在决定经验性抗真菌治疗时应考虑先前住院时间的长短。
