The impact of commonly administered ceftriaxone, piperacillin-tazobactam, and imipenem-cilastatin on human candida colonization

Abstract

Aim: Contrary to common belief, current literature lacks data comparing the individual effects of different antibiotic agents on candidal colonization across multiple body sites. We investigated the impact of ceftriaxone (CRO), piperacillin-tazobactam (TZP), and imipenem-cilastatin (IMP) on human candidal colonization.

Methods: Patients who received CRO, TZP, or IMP for 7–14 days between February 26 and October 26, 2011, were included. A control group was also enrolled. Cultures for Candida species were obtained from the mouth, rectum, urine, and skin. The candida colonization index (CCI) was recorded on days 0, 7, and 14 for each group. We examined whether there was a notable increase in the initial CCI values across the three drug groups, analyzed differences between these groups, and evaluated the impact of antibiotics on Candida colonization at the species level.

Results: CRO (n=23), TZP (n=14) and IMP (n=14) caused significant increases in CCI by day 7 primarily due to oral and rectal colonization (p=0.001, p<0.001 and p<0.001, respectively), with further increases observed by day 14 compared to the control group (n=48). The increase in CCI induced by IMP was significantly greater than that caused by CRO on both days 7 and 14, with no significant difference observed between IMP and TZP. The clinical CCI threshold value of 0.5 was reached around day 7 in the IMP group and by day 14 in the TZP group. Although not statistically significant, both CRO and IMP were associated with increased colonization by C. albicans and C. glabrata at the species level.

Conclusion: CRO, TZP and IMP increased CCI initially through oral and rectal colonization during the first week, followed by urinary colonization in the second week. IMP led to the most rapid and the strongest rise.