ANTIBIOTIC PATTERNS ASSOCIATED WITH FUNGAL COLONIZATION IN CRITICALLYILL SURGICAL PATIENTS

Fungal infections (FI) in surgical patients are increasing; mortality approaches 50 per cent. Prior studies identified factors predicting fu ngal colonization (FC) including broad spectrum antibiotics (BSA). Thi s study investigates antibiotic patterns predicting FC. Other risk fac tors and outcomes are analyzed. A total of 72 consecutive SICU patient s receiving greater than or equal to 7 days BSA were followed. None re ceived prophylactic antifungals. Input data: Age, APACHE II, surgical procedure, lines, ulcer prophylaxis, TPN duration, antibiotic/antifung al regimen. Outcome data: FC, FI, length of SICU and hospital stay, mo rtality. A total of 32 patients (44%) developed FC; five (16%) develop ed FI (P = 0.08). All infected patients died (P = 0.0002). FC of GU (2 5%), respiratory (19%), and GI (19%) tracts were common. Multiple site colonization occurred in 25 per cent of colonized patients. Metronida zole and duration of ventilation predicted FC. APACHE II and TPN durat ion predicted mortality. Mortality occurred exclusively among patients requiring systemic antifungals. Among BSA, only metronidazole indepen dently predisposed to FC. Other predictors of colonization and mortali ty agree with prior studies. The high mortality among patients requiri ng systemic antifungals implies that a more aggressive approach to pro phylaxis may be warranted.