Epidemiology and Risk Factors for Antifungal Resistance in Patients with Candidemia

Abstract

Abstract Background Candida is a common nosocomial blood pathogen associated with high mortality. Data on antifungal resistance from Saudi Arabia is scarce. The objective of this study is to examine epidemiology, risk factors for antifungal resistance, and outcome among patients with candidemia. Methods A retrospective study conducted at King Faisal Specialist Hospital and Research Center-Jeddah branch (KFSHRC-J) The study included all patients 18 years and older with positive blood culture for candida over a 5-year period (2012–2016). Results We identified 92 cases of candidemia. The mean age was 59 years SD (18). Candida galabrata was the most prominent species 33 (36%) followed by Candida parapsilosis 22 (24%), Candida albican 20 (22%), Candida tropicalis 13 (14%), Candida krusei 2 (2%), and others 2 (2%). Resistance to fluconazole was identified in 14 (15%) cases, four of them were also resistance to voriconazole. Among cases resistance to fluconazole, seven (50%) cases were C. parapsilosis, two (14%) of each C. galabrata, C.krusei, and C. Albicans and one (7%) was C. tropicalis. In univariate analysis, previous exposure to echanicancdin and mechanical ventilation within 3 months were associated with fluconazole resistance candidemia (12(15%) vs 7(50%), (P = 0.007), 28(36%) vs 10(71%), (P = 0.014), respectively). Patients with fluconazole resistance candida had a longer length of intensive care unit stay (median 26 days (IQR 6–40) days and 12 days (IQR 7–36)), respectively. Length of hospital stay was longer in patients with fluconazole resistance compared with nonresistance (median 83 days (IQR 29–199 days) and (31 days (IQR 17–75), respectively. Thirty-day mortality of patients fluconazole resistance compared with non-resistance cases was not significant 43 and 55%, respectively (P = 0.28). Conclusion In our cohort, Candida galabrata is the most common species causing candidemia. Increasing fluconazole resistance candida parapsilosis is alarming. More regional epidemiological antifungal resistance studies are required to confirm this finding. Disclosures All authors: No reported disclosures.