ANTIBIOTIC REGIMEN AS AN INDEPENDENT RISK FACTOR FOR DISSEMINATED FUNGAL-INFECTIONS IN NEUTROPENIC PATIENTS IN BRAZIL

In a cohort of 79 febrile episodes in 50 consecutive neutropenic patie nts seen at the University Hospital, Federal University of Rio de Jane iro, Brazil, between 1987 and 1991, it was observed that the cumulativ e incidence of disseminated fungal infections rose from 3% to 19% afte r the introduction of a new empirical antibiotic regimen. In order to identify risk factors, as well as to assess the impact of the new anti biotic regimen on the emergence of fungal infections, a nested case-co ntrol study was undertaken, in which 10 cases of disseminated fungal i nfections were compared with 30 randomly chosen controls, drawn from t he same cohort. In a multiple logistic regression analysis, the predic tive factors for disseminated fungal infection were younger age (odds ratio 0.85, 95% confidence interval 0.75-0.97) and use of the new anti biotic regimen (odds ratio 14.18, 95% confidence interval 1.05-191.80) The probable explanation for the emergence of fungal infections is th at the new antibiotic regimen, by lowering the incidence of bacteraemi a-related deaths, allowed patients to be at risk for the development o f disseminated fungal infections.