Variables Associated With Poor Clinical Outcomes in Patients With Serious Fluconazole Non-Susceptible Candida Species...

Antifungal resistance among Candida species has become increasingly prevalent in recent years.

This study aims to identify independent predictors for poor outcomes associated with serious clinical infections caused by fluconazole non-susceptible Candida sp. across the Veterans Health Administration.

This retrospective, observational, nationwide analysis included adults admitted to any Veterans Affairs Medical Center (VAMC) between January 1, 2009, and September 30, 2024, with positive cultures (or rapid diagnostic test) for Candida sp. from otherwise-sterile sites. Multivariate logistic regression assessed associations with the 30-day mortality in patients with these Candida sp. infections, regardless of fluconazole susceptibility.

Eligible cases were found from 1613 patients with 1651 culture episodes from otherwise-sterile sites detecting Candida sp. with available fluconazole susceptibility data. Non-susceptible Candida sp. was discovered in 261 of these episodes. Independent variables associated with 30-day mortality in fluconazole non-susceptible infection included reduced serum bicarbonate, thrombocytopenia, recent exposure to the macrolide/tetracycline/clindamycin antibiotics, elevated blood urea nitrogen, and lack of recent outpatient surgery. In the propensity-matched comparison, 30-day mortality between the 2 groups was not statistically significant: 26.6% for episodes with susceptible fluconazole isolates vs 24.9% for non-susceptible episodes (139/522 vs 65/251; P = 0.60).

Several host-derived physiological markers and recent exposure to protein synthesis inhibitor antibiotics were independent variables associated with 30-day mortality in patients with non-susceptible serious Candida sp.

This information may guide clinicians toward strategies to improve the clinical outcomes of these patients.