Antibiotic patterns associated with fungal colonization in critically ill surgical patients.

Fungal infections (FI) in surgical patients are increasing; mortality approaches 50 per cent. Prior studies identified factors predicting fungal colonization (FC) including broad spectrum antibiotics (BSA). This study investigates antibiotic patterns predicting FC. Other risk factors and outcomes are analyzed. A total of 72 consecutive SICU patients receiving > or = 7 days BSA were followed. None received prophylactic antifungals. Input data: Age, APACHE II, surgical procedure, lines, ulcer prophylaxis, TPN duration, antibiotic/antifungal regimen. Outcome data: FC, FI, length of SICU and hospital stay, mortality. A total of 32 patients (44%) developed FC; five (16%) developed FI (P = 0.08). All infected patients died (P = 0.0002). FC of GU (25%), respiratory (19%), and GI (19%) tracts were common. Multiple site colonization occurred in 25 per cent of colonized patients. Metronidazole and duration of ventilation predicted FC. APACHE II and TPN duration predicted mortality. Mortality occurred exclusively among patients requiring systemic antifungals. Among BSA, only metronidazole independently predisposed to FC. Other predictors of colonization and mortality agree with prior studies. The high mortality among patients requiring systemic antifungals implies that a more aggressive approach to prophylaxis may be warranted.