Role of Candida in antibiotic-associated diarrhea

To quantitatively assess the role of Candida species in antibiotic-associat ed diarrhea (AAD), stool samples from a total of 395 patients and control s ubjects were cultured in differential isolation medium: 98 patients had AAD , 93 patients were taking antibiotics but did not have diarrhea (A(+)D(-)), 97 patients were not taking antibiotics but had diarrhea (A(-)D(+)), and 1 07 patients were control subjects (A(-)D(-)). In addition, secreted asparty l proteinase (Sap) production was tested. In AAD patients, Candida positivi ty (77/98) and Candida overgrowth (62/98) were not different from that amon g A(+)D(-) patients (75/93 [P = .860] and 52/93 [P = .375], respectively). Candida overgrowth among A(-)D(+) patients (40/97, P = .003) was less frequ ent than among AAD patients, but Candida positivity was not different (80/9 7, P = .612). In control subjects, Candida positivity and overgrowth were l ess common than in all other groups. Production of Sap did not differ betwe en patients with AADand control subjects (P = .568 and P = .590, respective ly). Data indicate that elevated Candida counts are a result of antibiotic treatment or diarrhea rather than a cause of AAD.