Parasitology-Mycology Laboratory, Infectious Agent Department, Albert Michallon University Hospital and Joseph Fourier University, Grenoble, France.
J Antimicrob Chemother. 2011 Dec;66(12):2880-6. doi: 10.1093/jac/dkr394. Epub 2011 Oct 6.
Antifungal prescription practices have changed over the last decade, and the impact of these changes is unclear. Our objective here was to evaluate the effect of antifungal drug use on the distribution and drug susceptibility of Candida spp. in a French intensive care unit (ICU).
Antifungal drug use was measured as the number of defined daily doses per 1000 hospital days (DDDs/1000HD). The distribution of Candida spp. over a 6 year period (2004-09) and the MICs of antifungal drugs over 2007-09 were determined. Statistical analyses were performed to assess relationships between antifungal drug use, Candida spp. distribution and MIC changes over time.
Of 26,450 samples from 3391 patients, 1511 were positive for Candida spp. Candida albicans predominated (52.5%), followed by Candida glabrata (16.6%) and Candida parapsilosis (7.5%). C. parapsilosis increased significantly, from 5.7% in 2004 to 12.5% in 2009 (P = 0.0005). Caspofungin use increased significantly between 2004 (17.9 DDDs/1000HD) and 2009 (69.9 DDDs/1000HD) (P < 0.0001). Between 2007 and 2009, the increase in caspofungin use correlated significantly with the increase in caspofungin MICs displayed by C. parapsilosis (P < 0.0001) and C. glabrata (P = 0.03). Amphotericin B consumption changed over time and correlated with an increase in amphotericin B MICs for C. albicans (P = 0.0002) and C. glabrata (P = 0.0005). Significant declines occurred in both fluconazole use (P < 0.0001) and fluconazole MICs of C. albicans (P < 0.001)
Antifungal drug use in the ICU is associated with major changes in the distribution and drug susceptibility of Candida spp.
过去十年中，抗真菌药物的使用情况发生了变化，但其影响尚不清楚。本研究旨在评估法国重症监护病房（ICU）中抗真菌药物使用对念珠菌属分布和药敏性的影响。
采用每 1000 个住院日的限定日剂量数（DDD/1000HD）来衡量抗真菌药物的使用情况。在 2004 年至 2009 年的 6 年期间，确定了念珠菌属的分布情况和 2007 年至 2009 年抗真菌药物的 MIC 值。采用统计学分析评估抗真菌药物使用、念珠菌属分布和 MIC 随时间变化之间的关系。
在 3391 例患者的 26450 份样本中，有 1511 份样本为念珠菌属阳性。最常见的是白色念珠菌（52.5%），其次是光滑念珠菌（16.6%）和近平滑念珠菌（7.5%）。近平滑念珠菌的比例显著增加，从 2004 年的 5.7%增加到 2009 年的 12.5%（P=0.0005）。2004 年（17.9 DDDs/1000HD）至 2009 年（69.9 DDDs/1000HD）期间，卡泊芬净的使用显著增加（P<0.0001）。2007 年至 2009 年期间，卡泊芬净使用量的增加与近平滑念珠菌（P<0.0001）和光滑念珠菌（P=0.03）对卡泊芬净 MIC 值的增加显著相关。两性霉素 B 的消耗量随时间而变化，并与白色念珠菌（P=0.0002）和光滑念珠菌（P=0.0005）对两性霉素 B MIC 值的增加相关。氟康唑的使用量（P<0.0001）和白色念珠菌的氟康唑 MIC 值（P<0.001）均显著下降。
ICU 中抗真菌药物的使用与念珠菌属的分布和药敏性发生重大变化有关。
