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Published on: December 28, 2017
Risk factors associated with fluconazole resistance in Candida parapsilosis candidemia: A case-case study
Sabri Atalay1, Derya Çağlayan2, Eren Arkalı3
1Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey.
Background:
Candida species are among the most important invasive pathogens in intensive care units (ICUs). Non-albicans species including Candida parapsilosis (C. parapsilosis) has increased in recent years. Fluconazole is the leading antifungal agent but resistance is a concern among C. parapsilosis species.
Objectives:
The aim of this study was to determine the factors associated with fluconazole resistance in patients with candidemia due to C. parapsilosis in ICUs.
Methods:
This case-case study was conducted in a 750-bed, tertiary hospital between 2015 and 2021. Patients with fluconazole-resistant C. parapsilosis candidemia constituted the 'cases of interest' group and patients with fluconazole-susceptible C. parapsilosis candidemia constituted the 'comparison cases' group. Demographic and clinical data of the patients were recorded. Logistic regression analysis was performed using the backward elimination method to determine the independent predictors of fluconazole-resistant C. parapsilosis bloodstream infections.
Results:
The study included 177 patients. In the cultures of these patients, 76 (43%) fluconazole-resistant, 13 (7.3%) fluconazole-reduced susceptible, and 88 (49.7%) fluconazole-susceptible isolates were found. In the regression analysis the risk factors for fluconazole-resistant C. parapsilosis bloodstream infection, malignancy, immunosuppressive treatment, history of intra-abdominal surgery, hypoalbunemia, previous fluconazole use, and SOFA score were found to be associated in univariate analysis. In multivariate regression analysis, history of intra-abdominal surgery (OR: 2.16; 95% CI: 1.05-4.44), hypoalbuminemia (OR: 2.56; 95% CI: 1.06-6.17) and previous fluconazole use (OR: 3.35; 95% CI: 1.02-11) were found to be independent predictors.
Conclusions:
In this study, a significant correlation was found between candidemia due to fluconazole-resistant C. parapsilosis in ICUs and intra-abdominal surgery, hypoalbuminemia, and previous fluconazole use. C. parapsilosis isolates and fluconazole resistance should be continuously monitored, strict infection control measures should be taken and antifungal stewardship programs should be implemented.
Insights
Fluconazole resistance in Candida parapsilosis bloodstream infections is linked to intra-abdominal surgery, low albumin levels, and prior fluconazole use in intensive care units. Continuous monitoring and antifungal stewardship are recommended.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Critical Care Medicine
Background:
- Candida species are leading invasive pathogens in intensive care units (ICUs).
- Non-albicans Candida species, particularly Candida parapsilosis (C. parapsilosis), are increasingly prevalent.
- Fluconazole resistance in C. parapsilosis poses a significant clinical challenge.
Purpose of the Study:
- To identify factors associated with fluconazole resistance in C. parapsilosis candidemia.
- To investigate predictors of fluconazole-resistant C. parapsilosis bloodstream infections in ICU patients.
Main Methods:
- A case-case study design comparing fluconazole-resistant and fluconazole-susceptible C. parapsilosis candidemia.
- Data collected from 2015-2021 at a tertiary hospital.
- Logistic regression analysis, including backward elimination, to determine independent predictors.
Main Results:
- Out of 177 patients, 43% had fluconazole-resistant C. parapsilosis isolates.
- Univariate analysis identified malignancy, immunosuppressive treatment, intra-abdominal surgery, hypoalbuminemia, previous fluconazole use, and SOFA score as risk factors.
- Multivariate analysis revealed intra-abdominal surgery (OR: 2.16), hypoalbuminemia (OR: 2.56), and previous fluconazole use (OR: 3.35) as independent predictors.
Conclusions:
- Intra-abdominal surgery, hypoalbuminemia, and prior fluconazole use are significantly correlated with fluconazole-resistant C. parapsilosis candidemia in ICUs.
- Continuous monitoring of C. parapsilosis isolates and antifungal resistance is crucial.
- Implementation of strict infection control and antifungal stewardship programs is recommended.
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