Risk factors associated with fluconazole resistance in Candida parapsilosis candidemia: A case–case study

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. parapsilosi...

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Published in:Mycoses 2024-03, Vol.67 (3), p.e13717-n/a
Main Authors: Atalay, Sabri, Çağlayan, Derya, Arkalı, Eren, Sönmez, Ufuk, Şamlıoğlu, Pınar
Format: Article
Language:English
Subjects:
Abdomen
Abdominal surgery
Antifungal Agents - pharmacology
Antifungal Agents - therapeutic use
Candida parapsilosis
Candidemia
Candidemia - drug therapy
Candidemia - epidemiology
Candidemia - microbiology
Case studies
Drug Resistance, Fungal
Fluconazole
Fluconazole - pharmacology
Fluconazole - therapeutic use
Humans
Hypoalbuminemia
Intensive care units
Malignancy
Microbial Sensitivity Tests
Patients
Regression analysis
Risk Factors
Surgery
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Summary: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.
ISSN:0933-7407
1439-0507
DOI:10.1111/myc.13717