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LETTER TO THE EDITOR

Fluconazole Exposure and Selection for Candida Non-albicans

Department of Medicine and Health Sciences; Ghent University, Ghent, Belgium (Vandijck) Department of Medicine and Health Sciences; Ghent University, Ghent, Belgium; General Internal Medicine and Infectious Diseases; Ghent University Hospital, Ghent, Belgium; stijn.blot{at}ugent.be (Blot) General Internal Medicine and Infectious Diseases; Ghent University Hospital, Ghent, Belgium (Vandekerckhove) Department of Medicine and Health Sciences; Ghent University, Ghent, Belgium; General Internal Medicine and Infectious Diseases; Ghent University Hospital, Ghent, Belgium; Department of Healthcare; University College Ghent, Ghent, Belgium (Vogelaers)

To the Editor:

Similar to a recent report by Dimopoulos et al.,1 who was not able to demonstrate azole prophylaxis as a risk factor for development of Candida non-albicans infection, (P = 0.75), we too found no relationship between the volume of fluconazole consumption and shifts towards more Candida non-albicans (P = 0.81).2 Although we agree with prior reports suggesting fluconazole as a risk factor for non-C. albicans infection3–5 rather than a lack of power, these negative results may be explained by the less important role of horizontal transmission in the pathogenesis of Candida colonization and infection and the stronger ability of bacteria to exchange resistance patterns by plasmid transfer.

REFERENCES

1. Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME. Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 2008;106:523–9[Abstract/Free Full Text]
2. Blot S, Janssens R, Claeys G, Hoste E, Buyle F, De Waele JJ, Peleman R, Vogelaers D, Vandewoude K. Effect of fluconazole consumption on long-term trends in Candidal ecology. J Antimicrob Chemother 2006;58:474–7[Abstract/Free Full Text]
3. Blot S, Vandewoude K, Hoste E, Poelaert J, Colardyn F. Outcome in critically ill patients with candidal fungaemia: Candida albicans vs. Candida glabrata. J Hosp Infect 2001;47:308–13[Web of Science][Medline]
4. Snydman DR. Shifting patterns in the epidemiology of nosocomial Candida infections. Chest 2003;123:500S–3S[Web of Science][Medline]
5. Blot S, Vandewoude K. Management of invasive candidiasis in critically ill patients. Drugs 2004;64:2159–75[Web of Science][Medline]

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