Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Fluconazole Use as an Important Risk Factor in the Emergence of Fluconazole-Resistant Candida glabrata Fungemia—Reply

Fluconazole Use as an Important Risk Factor in the Emergence of Fluconazole-Resistant Candida... In reply We thank Tumbarello and colleagues for their insightful comments. Their article evaluated risk factors, antifungal treatment, and outcomes in 14 patients with fluconazole–less-susceptible Candida glabrata bloodstream infections and 21 patients with fluconazole-susceptible C glabrata bloodstream infections.1 Similar to our results, the authors identified fluconazole use as a significant risk factor for fluconazole–less-susceptible C glabrata isolates. This provides further evidence supporting the role of fluconazole use in the emergence of fluconazole resistance. Their study additionally identified diabetes mellitus as an independent risk factor for fluconazole–less-susceptible isolates, while surgery was found to be an independent risk factor for fluconazole-susceptible isolates. Central venous catheter use was found to be a significant risk factor in both analyses, suggesting that this may be a risk factor for C glabrata bloodstream infections in general, regardless of fluconazole susceptibility. The authors are correct that our study did not evaluate these variables. Central venous catheter use was not included in our analysis because of concern for data accuracy. At our institution, central venous catheters are often placed by house staff, which occurs without an order being placed into the electronic database and therefore would not be captured by the Pennsylvania Integrated Clinical and Administrative Research Database. Diabetes mellitus and general surgery were not evaluated because no studies prior to the time we submitted our manuscript had found an association between these factors and C glabrata bloodstream infections. We agree with Tumbarello and colleagues on the importance of evaluating clinical outcomes in this population. A study is under way to determine whether mortality rates differ in patients with C glabrata bloodstream infections based on fluconazole susceptibility. Lastly, future studies should evaluate interventions designed to curb fluconazole resistance in C glabrata isolates. Correspondence: Dr Lee, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Ste E, Philadelphia, PA 19104 (ingi.lee@uphs.upenn.edu). References 1. Tumbarello MSanguinetti MTrecarichi E et al. Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. J Antimicrob Chemother 2008;62 (6) 1379- 1385PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Fluconazole Use as an Important Risk Factor in the Emergence of Fluconazole-Resistant Candida glabrata Fungemia—Reply

Loading next page...
 
/lp/american-medical-association/fluconazole-use-as-an-important-risk-factor-in-the-emergence-of-G0SELjv6VI
Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2009.244
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Tumbarello and colleagues for their insightful comments. Their article evaluated risk factors, antifungal treatment, and outcomes in 14 patients with fluconazole–less-susceptible Candida glabrata bloodstream infections and 21 patients with fluconazole-susceptible C glabrata bloodstream infections.1 Similar to our results, the authors identified fluconazole use as a significant risk factor for fluconazole–less-susceptible C glabrata isolates. This provides further evidence supporting the role of fluconazole use in the emergence of fluconazole resistance. Their study additionally identified diabetes mellitus as an independent risk factor for fluconazole–less-susceptible isolates, while surgery was found to be an independent risk factor for fluconazole-susceptible isolates. Central venous catheter use was found to be a significant risk factor in both analyses, suggesting that this may be a risk factor for C glabrata bloodstream infections in general, regardless of fluconazole susceptibility. The authors are correct that our study did not evaluate these variables. Central venous catheter use was not included in our analysis because of concern for data accuracy. At our institution, central venous catheters are often placed by house staff, which occurs without an order being placed into the electronic database and therefore would not be captured by the Pennsylvania Integrated Clinical and Administrative Research Database. Diabetes mellitus and general surgery were not evaluated because no studies prior to the time we submitted our manuscript had found an association between these factors and C glabrata bloodstream infections. We agree with Tumbarello and colleagues on the importance of evaluating clinical outcomes in this population. A study is under way to determine whether mortality rates differ in patients with C glabrata bloodstream infections based on fluconazole susceptibility. Lastly, future studies should evaluate interventions designed to curb fluconazole resistance in C glabrata isolates. Correspondence: Dr Lee, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Ste E, Philadelphia, PA 19104 (ingi.lee@uphs.upenn.edu). References 1. Tumbarello MSanguinetti MTrecarichi E et al. Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. J Antimicrob Chemother 2008;62 (6) 1379- 1385PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 10, 2009

Keywords: fluconazole,fungemia,candida glabrata

References