Methods: We conducted a retrospective observational study at a tertiary care children’s hospital with 490-bed capacity, between January 2010 and December 2014. Annual data was collected for patient days, antimicrobial usage including broad-spectrum antibiotics and antifungal agents, number of microbial specimens, detection rate of Candida spp., and their susceptibility pattern. We calculated days of therapy (DOT) per 1000 patient days of antimicrobial agents by year. The correlation between the DOT of antimicrobials and the detection rate of Candida spp. per 1000 patient days or their resistance rate for the corresponding antimicrobials were analyzed using Spearman’s correlation.
Results: During the study period, hospitalization rates (mean:138,672 total hospitalization days per year [range:127,423-146,769]), total number of culture specimens (27,328 per year [24,536-31,355]), and detection rate of Candida spp. (1.6% [1.5-1.7]) remained steady while the detection rate of non-C. albicans gradually increased from 50% to 75%. There was a statistically significant positive correlation between total antifungal DOT and rate of detection of Candida spp. per 1000 patient days (r=0.891, p=0.043) suggesting that antifungals were used primarily for the treatment of fungal infection rather than prophylaxis. However, there was no significant correlation between the antifungal resistance rate and their corresponding antifungal DOT. Interestingly, there was a strong correlation between the rate of Candida spp. detected and the antibiotic DOT for vancomycin and teicoplanin (r=0.943, p=0.016) and broad-spectrum antibiotics including meropenem, piperacillin/tazobactam, and cefepime (r=0.749, p=0.145), suggesting that antibacterial use promotes candida colonization or infection.
Conclusion: The detection rate of Candida spp. positively correlated with DOT of broad-spectrum antibiotics, especially anti-methicillin-resistant Staphylococcus aureus agents. Further research regarding the benchmark for promoting antifungal stewardship is warranted.
I. Miyairi, Dainippon sumitomo: speaker at a sponsored program , Speaker honorarium
Kyorin pharmaceuticals: speaker at sponsored lecture , Speaker honorarium
Astellas: speaker at sponsored lecture , Speaker honorarium
Teijin pharm: speaker at sponsored lecture , Speaker honorarium
Daiichi sankyo: speaker at sponsored lecture , Speaker honorarium
Takeda pharm: speaker at sponsored lecture , Speaker honorarium
Tanabe mitsubishi: speaker at sponsored lecture , Speaker honorarium
Janssen: Grant Investigator , Research grant
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