Impact of Duration and Spectrum of Antibiotic Exposure on Risk for Hospital-onset Candidemia

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Background: Numerous studies have found broad-spectrum antibiotic exposure to be a risk factor for invasive candidiasis, but the risk of candidemia across the spectrum of antibiotic activity and duration of therapy is not well-defined. This retrospective study aims to characterize the hazard for candidemia with respect to depth and breadth of antibiotic exposure among hospitalized adults.

Methods: In this retrospective cohort study of adults admitted to a three-hospital health system from 2016 to 2021, we assessed the impact of duration and spectrum of antibiotic exposure as a risk factor for development of hospital-onset candidemia. Days of antibiotic spectrum coverage for groups of antibiotics were determined using an antimicrobial spectrum index. A proportional hazard regression model was constructed to contextualize the impact of antibiotic exposure among other established risk factors for invasive candidiasis.

Results: Over 1.2 million days of antibiotic therapy were administered across 162,913 hospital admissions, which included 236 episodes of hospital-onset candidemia. Broad-spectrum antibiotic administration was associated with increased hazard for candidemia in univariable analysis only. Among patients who developed candidemia, broader antibiotic exposure was associated with earlier-onset candidemia, and these patients had high rates of comorbidity and severe illness. In multivariable analysis, neutropenia, shock, total parenteral nutrition use, cirrhosis, and acute renal failure, but not broad-spectrum antibiotics, were associated with increased hazard for candidemia.

Conclusions: Numerous prior studies have associated broad-spectrum antibiotic use with risk for invasive candidiasis. In this large cohort of hospitalized adults with high rates of antibiotic exposure, we did not find an association between duration/spectrum of antibiotic exposure and risk for hospital-onset candidemia when controlling for other risk factors. Further study is warranted to assess the impact of dysbiosis on the risk of invasive candidiasis.






Dougherty, John (2023). Impact of Duration and Spectrum of Antibiotic Exposure on Risk for Hospital-onset Candidemia. Master's thesis, Duke University. Retrieved from


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