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Clinical factors associated with fluconazole resistance and short-term survival in patients with Candida bloodstream infection

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Abstract

In a 1-year national surveillance program of Candida bloodstream infections in Japan, clinical factors predicting fluconazole resistance and survival of the patients were analyzed. Blood isolates and complete clinical histories were obtained from 326 patients. Fluconazole-resistant isolates were found in 15 (4.6%) of the cases. Univariate analysis of the demographic and clinical factors associated with fluconazole resistance revealed that age, hematologic malignancy, neutropenia, and immunosuppression were of statistical significance. A multiple logistic regression model showed that only hematologic malignancy as the underlying disease (odds ratio, 6.6; 95% confidence interval, 1.6–26.9; P=0.009) was independently associated with resistance. In 242 cases in which data regarding management and prognosis were available, the 30-day survival rate was 68.4%. In the univariate analysis of factors predicting survival, a significant association was found for Candida species, age of the patient, neutropenia, recent abdominal surgery, removal of the central venous catheter, and use of appropriate antifungal therapy. In the multivariate analysis, removal of the central venous catheter (odds ratio, 6.0; 95% confidence interval, 2.2–16.1; P<0.001) and the use of appropriate therapy (odds ratio, 2.1; 95% confidence interval, 1.1–4.1; P=0.03) were independent factors significantly associated with survival after the diagnosis of Candida bloodstream infection.

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Acknowledgements

This study was supported in part by a grant-in-aid (no. 14572182) for scientific research from the Japan Society for the Promotion of Science, and by a research grant from Pfizer Pharmaceuticals. We express our appreciation to all the Japan Invasive Mycosis Surveillance (JIMS) study participants for providing isolates and clinical data, and to Izumi Sone and Koshu Kinoshita for their clerical assistance.

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  1. Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 6068507, Japan

    S. Takakura, N. Fujihara, T. Kudo, Y. Iinuma & S. Ichiyama

  2. KKR Takamatsu Hospital, 4-18 Tenjin-mae, Takamatsu, Kagawa, 7600018, Japan

    T. Saito

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  1. S. Takakura
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  2. N. Fujihara
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Japan Invasive Mycosis Surveillance Study Group

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Correspondence to S. Takakura.

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Takakura, S., Fujihara, N., Saito, T. et al. Clinical factors associated with fluconazole resistance and short-term survival in patients with Candida bloodstream infection. Eur J Clin Microbiol Infect Dis 23, 380–388 (2004). https://doi.org/10.1007/s10096-004-1128-2

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