title: Association of clinical and demographic factors in invasive candidiasis caused by fluconazole-resistant Candida species: a study in 15 hospitals, Medellín, Colombia 2010-2011.
abstract: Candida is the most important agent of fungal infections. Several risk factors have been described associated with invasive infection by fluconazole-resistant Candida spp. A prospective cross-sectional study with case-control analysis was conducted. Case group patients with fluconazole-resistant Candida isolate were included; control group were patients with fluconazole-susceptible Candida spp. A multivariate logistic regression model was performed. Three hundred isolates of Candida spp. were analyzed. Most frequent species were Candida albicans/Candida dubliniensis (48.3%) and Candida tropicalis (22.3%). Posaconazole susceptibility was 93.7%; voriconazole, 84%; and fluconazole, 78.7%. Susceptibility to anidulafungin and caspofungin was 92.7% and 92.3%, respectively. Neutropenia (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 1.0-43.1), antifungal exposure (aOR 5.1, 95% CI 2.3-11.2), and antituberculosis therapy (aOR 7.7, 95% CI 1.4-43.2) were associated to fluconazole resistance. Susceptibility results are useful to guide the selection of empiric antifungal treatment and the design of local therapeutic guidelines. Previous antifungal exposure suggests possible resistance to fluconazole, pointing towards the selection of a different class of antifungal agents.
authors.affiliation: Laboratorio Médico de Referencia, Clínica El Rosario, Medellín, Colombia; Grupo GERMEN, Medellín, Colombia.
authors.forename: Natalia Andrea
authors.initials: NA
authors.lastname: Maldonado
authors.affiliation: Unidad de Micología Médica y Experimental (MME), Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; Escuela de Microbiología de la Universidad de Antioquia (UdeA), Medellín, Colombia.
authors.forename: Luz Elena
authors.initials: LE
authors.lastname: Cano
authors.affiliation: Unidad de Micología Médica y Experimental (MME), Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.
authors.forename: Catalina
authors.initials: C
authors.lastname: De Bedout
authors.affiliation: Laboratorio Clínico y Servicio de Medicina Transfusional, Clínica Universitaria Bolivariana, Medellín, Colombia.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Arbeláez
authors.affiliation: Clínica CardioVID, Medellín, Colombia; Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Roncancio
authors.affiliation: Unidad de Micología Médica y Experimental (MME), Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.
authors.forename: Angela María
authors.initials: AM
authors.lastname: Tabares
authors.affiliation: Laboratorio Médico de Referencia, Clínica El Rosario, Medellín, Colombia; Grupo GERMEN, Medellín, Colombia.
authors.forename: Carlos Gonzalo
authors.initials: CG
authors.lastname: Robledo
authors.affiliation: Laboratorio Médico de Referencia, Clínica El Rosario, Medellín, Colombia; Grupo GERMEN, Medellín, Colombia.; Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia. Electronic address: jrobledo@labmedico.com.
authors.forename: Jaime
authors.initials: J
authors.lastname: Robledo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003105:Colombia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003710:Demography; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Antifungal susceptibility; Candidiasis; Fluconazole resistance; Risk factors