title: Risk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: An analysis from the China Survey of Candidiasis study.
abstract: OBJECTIVE
  To assess the risk factors for invasive Candida infection (ICI) caused by fluconazole-resistant (Flu-R) Candida species in intensive care unit (ICU) patients.
  
  
  METHODS
  Data from China Survey of Candidiasis study were analyzed. Patients with proven ICI were classified into fluconazole-sensitive (Flu-S) and Flu-R groups. Independent risk factors for Flu-R ICI were identified using a multivariate logistic regression.
  
  
  RESULTS
  Forty-one percent of ICI patients were infected with Flu-R Candida. Significantly more patients had Candida colonization, intra-abdominal hypertension, and antifungal therapy at least 7 days before diagnosis; fewer patients had gastrointestinal perforation, systemic inflammatory response syndrome manifestation, and fluoroquinolone exposure in the Flu-R group. Furthermore, hospital or ICU stay before onset of infection was longer in the Flu-R group than in the Flu-S group (hospital or ICU stay: 19 vs 13 days or 10.5 vs 8 days, P < .05). Also, it was demonstrated as an independent risk factor for Flu-R Candida infection.
  
  
  CONCLUSIONS
  As many as 41% of ICI patients were infected with Flu-R Candida, and the main risk factor was longer ICU stay before onset of ICI, implying that caution should be exercised when treating patients who have been long stayed in ICU with fluconazole as the first-line drug before testing isolates for drug sensitivity.
authors.affiliation: Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Xuelian
authors.initials: X
authors.lastname: Liao
authors.affiliation: Zhongda Hospital, Southeast University, Nanjing, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
authors.affiliation: Peking University First Hospital, Research Center for Medical Mycology, Peking University, Beijing, China.
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Li
authors.affiliation: Zhongda Hospital, Southeast University, Nanjing, China.
authors.forename: Fengmei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Peking University First Hospital, Research Center for Medical Mycology, Peking University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Microbiology Laboratory, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China. Electronic address: kang_yan_123@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification / Q000502:physiology*; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003422:Critical Care; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D007416:Intestinal Perforation / Q000453:epidemiology; D059325:Intra-Abdominal Hypertension / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Fluconazole resistance; Intensive care unit; Invasive Candida infection; Invasive candidiasis