Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection

Ronen Ben-Ami*, Keren Olshtain-Pops, Michal Krieger, Ilana Oren, Jihad Bishara, Michael Dan, Yonit Wiener-Well, Miriam Weinberger, Oren Zimhony, Michal Chowers, Gabriel Weber, Israel Potasman, Bibiana Chazan, Imad Kassis, Itamar Shalit, Colin Block, Nathan Keller, Dimitrios P. Kontoyiannis, Michael Giladia

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

137 Scopus citations


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.

Original languageAmerican English
Pages (from-to)2518-2523
Number of pages6
JournalAntimicrobial Agents and Chemotherapy
Issue number5
StatePublished - May 2012
Externally publishedYes


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