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

IF 4.1 2区医学 Q1 DERMATOLOGY

Mycoses Pub Date : 2024-03-01 DOI:10.1111/myc.13717

Sabri Atalay, Derya Çağlayan, Eren Arkalı, Ufuk Sönmez, Pınar Şamlıoğlu

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引用次数: 0

Abstract

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.

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与副丝状念珠菌血症中氟康唑耐药性相关的风险因素：病例研究

背景：念珠菌是重症监护病房（ICU）中最重要的侵袭性病原体之一。近年来，包括副丝状念珠菌（C.parapsilosis）在内的非白色念珠菌病原体有所增加。氟康唑是主要的抗真菌药物，但副丝状念珠菌的耐药性令人担忧：本研究旨在确定重症监护病房中由副银屑病引起的念珠菌血症患者对氟康唑产生耐药性的相关因素：这项病例研究于 2015 年至 2021 年期间在一家拥有 750 张病床的三级医院进行。耐氟康唑副银屑病念珠菌血症患者构成 "相关病例 "组，氟康唑易感副银屑病念珠菌血症患者构成 "对比病例 "组。记录了患者的人口统计学和临床数据。采用反向排除法进行逻辑回归分析，以确定耐氟康唑副银屑病血流感染的独立预测因素：研究共纳入 177 名患者。在这些患者的培养物中，发现了 76 株（43%）氟康唑耐药分离株、13 株（7.3%）氟康唑减毒分离株和 88 株（49.7%）氟康唑易感分离株。回归分析发现，在单变量分析中，耐氟康唑副猪嗜血杆菌血流感染的风险因素与恶性肿瘤、免疫抑制治疗、腹腔内手术史、低白蛋白血症、既往使用氟康唑和 SOFA 评分有关。在多变量回归分析中，发现腹腔内手术史（OR：2.16；95% CI：1.05-4.44）、低白蛋白血症（OR：2.56；95% CI：1.06-6.17）和既往使用氟康唑（OR：3.35；95% CI：1.02-11）是独立的预测因素：本研究发现，重症监护病房和腹腔内手术中耐受氟康唑的副丝虫引起的念珠菌血症、低白蛋白血症和既往使用氟康唑之间存在明显的相关性。应持续监测伞菌分离株和氟康唑耐药性，采取严格的感染控制措施，并实施抗真菌管理计划。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.