title: Risk factors for fluconazole-resistant candidemia.
abstract: Previous studies have sought to determine the risk factors associated with candidemia caused by non-albicans Candida spp. or with potentially fluconazole-resistant Candida spp. (C. glabrata and C. krusei). Non-albicans Candida strains are a heterogeneous group that includes species with different levels of virulence, and only a limited number of C. glabrata isolates are resistant to fluconazole. We set out to identify the risk factors associated with microbiologically proven fluconazole-resistant candidemia. A prospective study including adult patients with candidemia was performed. Data were collected on patient demographics; underlying diseases; exposure to corticosteroids, antibiotics, or fluconazole; and invasive procedures. Risk factors associated either with non-albicans Candida spp. or potentially fluconazole-resistant Candida spp. (C. glabrata or C. krusei) or with Candida spp. with microbiologically confirmed fluconazole resistance were assessed using logistic regressions. We included 226 candidemia episodes. Non-albicans Candida isolates accounted for 53.1% of the fungal isolates, but only 18.2% of the cases were caused by potentially fluconazole-resistant organisms. Thirty isolates exhibited microbiologically confirmed fluconazole resistance. The multivariate analysis revealed that independent predictors associated with fluconazole-resistant Candida spp. were neutropenia (odds ratio [OR]=4.94; 95% confidence interval [CI]=1.50 to 16.20; P=0.008), chronic renal disease (OR=4.82; 95% CI=1.47 to 15.88; P=0.01), and previous fluconazole exposure (OR=5.09; 95% CI=1.66 to 15.6; P=0.004). Independently significant variables associated with non-albicans Candida bloodstream infection or with potentially fluconazole-resistant Candida spp. did not include previous fluconazole exposure. We concluded that prior fluconazole treatment is an independent risk factor only for candidemia caused by microbiologically confirmed fluconazole resistant species. Our findings may be of value for selecting empirical antifungal therapy.
authors.affiliation: Critical Care and Emergency Department, Intensive Care Unit, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, Seville 41013, Spain. jose.garnacho.sspa@juntadeandalucia.es
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Ana
authors.initials: A
authors.lastname: Díaz-Martín
authors.forename: Emilio
authors.initials: E
authors.lastname: García-Cabrera
authors.forename: Maite
authors.initials: M
authors.lastname: Ruiz Pérez de Pipaón
authors.forename: Clara
authors.initials: C
authors.lastname: Hernández-Caballero
authors.forename: Javier
authors.initials: J
authors.lastname: Aznar-Martín
authors.forename: José M
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Carlos
authors.initials: C
authors.lastname: Ortiz-Leyba
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000008:administration & dosage / Q000494:pharmacology*; D016469:Fungemia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008826:Microbial Sensitivity Tests; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole