Risk Factors for Fluconazole-Resistant Candidemia

Abstract

Bloodstream infections (BSIs) due to Candida species are a serious complication in hospitalized patients. Candidemia is associated with a high mortality rate and has obvious effects on resource use (11). Over the past few decades, the incidence of candidemia has increased markedly (2, 3). Moreover, the increment of candidemia caused by Candida species other than Candida albicans is a common finding in recent series (3, 12). These species include C. glabrata and C. krusei, which tend to be more resistant to fluconazole and therefore present a particular challenge for clinical management.Diverse studies highlight the importance of early and appropriate empirical therapy in invasive Candida infection (14, 21). Fluconazole is currently considered the initial therapy for most adult patients with candidemia (20). As the selection of empirical therapy is driven in large part by the likely epidemiology, there is a need to identify patients at risk of candidemia caused by species resistant to fluconazole in order to begin with adequate empirical antifungal therapy.In order to provide guidance to clinicians to initiate empirical treatment for candidemia, prior studies have addressed risk factors for candidemia caused by non-albicans Candida spp.(1, 9, 10, 23) or by potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) (16, 23, 28) but have not taken into consideration in vitro resistance to fluconazole. In these studies, prior fluconazole exposure was an independent risk factor for candidemia caused by non-albicans Candida species (1) or by potentially fluconazole-resistant species (23), whereas other studies did not find this association (16,28). Therefore, to the best of our knowledge, the risk factors for microbiologically proven fluconazole-resistant Candida spp. BSIs have not been comprehensively studied. We conducted the prospective single-center study described here to identify the variables associated with the diagnosis of fluconazole-resistant candidemia. Our working hypothesis was that fluconazole administration is an independent risk factor only in the emergence of BSIs caused by fluconazole-resistant Candida. MATERIALS AND METHODSHospital. The prospective study described here was carried out in the Virgen del Rocío University Hospital, a large urban hospital with teaching accreditation, from January 2004 to June 2009. The hospital has a solid organ (liver, heart, kidney) transplantation program and an active bone marrow transplantation

Evaluation of Candida species and antifungal susceptibilities among children with invasive candidiasis

“…Widespread use of triazoles in prophylactic and empirical treatment has led to an increase in Candida species with resistance to azoles. It was reported that previous FCZ treatment was an independent risk factor for candidemias, which are resistant to FCZ (17). Although differences are present in various studies, the rate of FCZ resistance ranges between 0.7% and 8.6% (18,19).…”

Recent Exposure to Caspofungin or Fluconazole Influences the Epidemiology of Candidemia: a Prospective Multicenter Study Involving 2,441 Patients

“…In addition, they have been associated with reduced survival in cancer patients with recent azole administration (17,38,45). The relationship between the increased incidence of these species and fluconazole prescription has been debated ever since the introduction of fluconazole as prophylaxis in hematology wards (1,15,33,46) and in ICUs (14). Interestingly, recent studies pointed out that a single dose of fluconazole was associated with an increased risk of candidemia due to non-C. albicans isolates (6) and noted a correlation between reduced fluconazole use and decreasing incidence of non-C. albicans candidemia (4).…”

Resistance Mechanisms and Clinical Features of Fluconazole-Nonsusceptible Candida tropicalis Isolates Compared with Fluconazole-Less-Susceptible Isolates

“…Previous azole exposure is an important risk factor for fungemia caused by fluconazole-resistant Candida isolates (28). However, the azole resistance of some clinical isolates of C. tropicalis may not be associated with previous exposure to azole agents (3).…”