Documented fungal infections after prophylaxis or therapy with wide spectrum antibiotics: Relationship between certain fungal pathogens and particular antimicrobials?

Antibiotics are known to be one of the major risk factors for fungal infect ion, We investigated whether there was a relationship between particular do cumented fungal infections and therapeutically or prophylactically administ ered antimicrobials in 105 patients with fungemia or histologically proven invasive aspergillosis or fusariosis. Out of 105 patients, 82.9% received a ntimicrobials affecting anaerobic microbial gut flora such as: imipenem, va ncomycin, ceftazidime, metronidazole, clindamycin or ampicillin-sulbactam. In addition, 44.5% of patients had received prophylaxis with ofloxacin, 31. 5% of Candida albicans fungemias occurred despite empiric therapy with amph otericin B and 21.1% during prophylaxis with azoles, The incidence of C. al bicans infections (fungemias) was significantly higher (58.9% vs 33.7%, p<0 .04) in patients receiving antibiotics not affecting anaerobic gut flora su ch as ofloxacin, an aminoglycoside or azithromycin, On the other hand, pati ents treated with third generation cephalosporins, carbapenems, glycopeptid es, and broad spectrum penicillins were more likely to develop proven invas ive Aspergillus spp, infection (27.9% vs 5.3%, p<0.001) in comparison to th ose treated with antimicrobials which preserve anaerobic gut flora.