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.
OBJECTIVE: 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.
OBJECTIVE: 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）中最重要的侵入性病原体之一。非白色念珠菌物种，包括近平滑念珠菌（C.近平滑)近年来有所增加。氟康唑是主要的抗真菌剂，但耐药性是近拉布氏杆菌物种中的一个问题。
目的：本研究的目的是确定ICU中近拉氏梭菌引起的念珠菌菌血症患者对氟康唑耐药的相关因素。
方法：本案例研究是在750张病床上进行的，2015年至2021年三级医院。氟康唑耐药念珠菌病阳性患者构成“关注病例”组，氟康唑敏感念珠菌病阳性患者构成“比较病例”组。记录患者的人口统计学和临床资料。采用后向消除法进行Logistic回归分析,确定氟康唑耐药近融合梭菌血流感染的独立预测因子。
结果：该研究包括177名患者。在这些患者的文化中，76（43%）氟康唑耐药，13（7.3％）氟康唑减少易感，发现88株(49.7%)氟康唑敏感株。在回归分析中，氟康唑耐药近融合梭菌血流感染的危险因素，恶性肿瘤，免疫抑制治疗,腹部手术史，低白蛋白血症,以前使用过氟康唑，和SOFA评分在单因素分析中发现相关。在多元回归分析中，腹部手术史（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)是独立预测因子.
结论：在这项研究中，在ICUs中发现由氟康唑耐药性梭菌引起的念珠菌菌血症与腹腔手术之间存在显着相关性，低蛋白血症,和以前使用氟康唑。应持续监测近平滑分离株和氟康唑耐药性，应采取严格的感染控制措施，并实施抗真菌管理计划。
目的：本研究的目的是确定ICU中近拉氏梭菌引起的念珠菌菌血症患者对氟康唑耐药的相关因素。
方法：本案例研究是在750张病床上进行的，2015年至2021年三级医院。氟康唑耐药念珠菌病阳性患者构成“关注病例”组，氟康唑敏感念珠菌病阳性患者构成“比较病例”组。记录患者的人口统计学和临床资料。采用后向消除法进行Logistic回归分析,确定氟康唑耐药近融合梭菌血流感染的独立预测因子。
结果：该研究包括177名患者。在这些患者的文化中，76（43%）氟康唑耐药，13（7.3％）氟康唑减少易感，发现88株(49.7%)氟康唑敏感株。在回归分析中，氟康唑耐药近融合梭菌血流感染的危险因素，恶性肿瘤，免疫抑制治疗,腹部手术史，低白蛋白血症,以前使用过氟康唑，和SOFA评分在单因素分析中发现相关。在多元回归分析中，腹部手术史（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)是独立预测因子.
结论：在这项研究中，在ICUs中发现由氟康唑耐药性梭菌引起的念珠菌菌血症与腹腔手术之间存在显着相关性，低蛋白血症,和以前使用氟康唑。应持续监测近平滑分离株和氟康唑耐药性，应采取严格的感染控制措施，并实施抗真菌管理计划。
