Abstract
Background:
Antifungal-resistant Candida species have become increasingly prevalent in recent years, posing significant therapeutic challenges in the inpatient setting. Despite their clinical relevance, comprehensive data evaluating risk factors for the development of invasive infections caused by Candida sp. with antifungal resistance are limited.
Objective:
This study aims to identify independent predictors for the development of invasive clinical infections caused by fluconazole-resistant or echinocandin-resistant Candida sp. in hospitalized veterans across the United States Veterans Health Administration.
Methods:
This retrospective, observational, nationwide analysis included adults ≥18 years admitted to any Veterans Affairs Medical Center between January 1, 2009, and September 30, 2024, with culture-positive or rapid diagnostic test-confirmed invasive Candida sp. infection from otherwise-sterile sites. Data were gathered on baseline demographics, baseline laboratory data, comorbid conditions, and exposure to antibacterial agents, antifungal agents, β-Hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase inhibitors, and immunosuppressant drug therapy. Univariate and multivariate logistic regression models were used to assess associations between clinical variables and the development of invasive fluconazole-resistant and echinocandin-resistant Candida sp. infections.
Results:
Eligible cases were found from 25 Veterans Affairs Medical Center facilities; 1651 episodes had available fluconazole susceptibility data, and 1117 episodes had echinocandin susceptibility data. Fluconazole non-susceptibility was independently associated with at least 7 days of recent exposure to either fluconazole or an echinocandin, among a few other variables. Echinocandin resistance, while less common, was strongly linked to the receipt of dialysis, prolonged Gram-positive antibacterial exposure, and any prior antifungal use.
Conclusions and Relevance:
These findings can inform antifungal stewardship efforts to curb the rise of resistant Candida sp.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
