Long Term Antibiotic Therapy Case Study
1.2.1 Exposure to long term antibiotic therapy
Long-term antibiotic therapy is one of the most extensively studied risk factors. Exposure to multiple and prolonged use of broad spectrum antimicrobials have been found to be independent risk factors for candidemia. The reason for this being, many of the antibiotics like beta-lactams and vancomycin used in the wards and intensive care unit (ICU) settings lead to the depletion of normal bacterial flora resulting in fungal overgrowth. The increasing use of oral vancomycin in the ICUs results in the depletion of anaerobic bacterial flora of the gut.
1.2.2 Intravascular Catheters and Central Venous Catheters
Intravascular catheters are also one of the important risk factors in the acquisition of candidemia. Candida species adhere avidly to materials used in intravascular catheters and provide a potential nidus for infection. Some species like Candida parapsilosis are especially implicated in intravascular catheter-related infections in neonates and in the paediatric age group. The role played by intravascular catheters in perpetuating candidemia has implications for its management. Removal of vascular catheters has been advocated as an adjunctive strategy for treating patients with catheter-related candidemia. However, there is some controversy regarding the benefits and risks of removal of vascular catheters in management of candidemia.
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However, patients with malignancies are at increased risk of developing candidemia because of a number of factors like cancer chemotherapy, longer duration of hospital stay and treatment with various
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