近平滑念珠菌菌血症中氟康唑耐药相关的危险因素：病例对照研究。

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

机构信息

Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey.

Department of Epidemiology, Diyarbakır Provincial Health Directorate, Diyarbakır, Turkey.

出版信息

Mycoses. 2024 Mar;67(3):e13717. doi: 10.1111/myc.13717.

DOI:10.1111/myc.13717

PMID:38544313

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.

摘要

背景

念珠菌属是重症监护病房（ICU）中最重要的侵袭性病原体之一。近年来，非白念珠菌属物种（包括近平滑念珠菌[C. parapsilosis]）的数量有所增加。氟康唑是主要的抗真菌药物，但念珠菌属物种的耐药性令人担忧。

目的

本研究旨在确定 ICU 中由近平滑念珠菌引起的念珠菌血症患者中与氟康唑耐药相关的因素。

方法

本病例对照研究于 2015 年至 2021 年在一家拥有 750 张床位的三级医院进行。氟康唑耐药的近平滑念珠菌念珠菌血症患者构成“感兴趣的病例”组，氟康唑敏感的近平滑念珠菌念珠菌血症患者构成“对照病例”组。记录患者的人口统计学和临床数据。使用向后消除法进行 logistic 回归分析，以确定氟康唑耐药的近平滑念珠菌血流感染的独立预测因素。

结果

本研究共纳入 177 例患者。在这些患者的培养物中，发现 76 株（43%）氟康唑耐药、13 株（7.3%）氟康唑降低敏感和 88 株（49.7%）氟康唑敏感的分离株。在回归分析中，恶性肿瘤、免疫抑制治疗、腹腔内手术史、低白蛋白血症、氟康唑使用史和 SOFA 评分与氟康唑耐药近平滑念珠菌血流感染相关，这些因素在单变量分析中被发现具有统计学意义。多变量回归分析发现，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）和氟康唑使用史（OR：3.35；95%CI：1.02-11）是独立的预测因素。