The frequency of and risk factors for Candida fungemia

Abstract

Objective: to describe the population of patients with candidemia, the risk factors for developing fluconazole-resistant candidemia, its frequency, and its 10-year distribution.

Materials and method: this was a multicenter retrospective cohort study enrolling patients with Candida spp. fungemia diagnosed between January 2010 and December 2020. Multivariate analysis was done using logistic regression to determine the risk factors associated with developing fungemia due to fluconazole-resistant species.

Results: there were 286 patients with Candida spp. fungemia; 19.9% of the isolates were fluconazole-resistant, and C. albicans was the most common species (38.8%). C. glabrata (26%), C. krusei (25%) and C. tropicalis (21%) predominated in the fluconazole-resistant group. Prior use of antifungals (OR 2.45; 95% CI 1.07–5.58; p = <0.033) and malnutrition (OR 2.34; 95% CI 1.11 – 4.65; p = 0.015) were independently related to the onset of fluconazole-resistant candidemia.

Conclusions: fungemia caused by non-albicans Candida species and fluconazole-resistant species has a high incidence and has been increasing over time. Prior use of antifungals is associated with developing fluconazole-resistant candidemia, as is malnutrition. This finding has not been reported in previous studies and warrants confirmation with further research. The effect of SARS-CoV-2 infection on the development of candidemias is well-known, and its actual impact on our population should be measured in future studies