Impact of Fluconazole Resistance on the Outcomes of Patients With Candida parapsilosis Bloodstream Infections: A Retrospective Multicenter Study.

IF 7.3 1区医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2025-03-17 DOI:10.1093/cid/ciae603

Antonio Vena, Giusy Tiseo, Marco Falcone, Claudia Bartalucci, Cristina Marelli, Mario Cesaretti, Vincenzo Di Pilato, Pilar Escribano, Arianna Forniti, Daniele Roberto Giacobbe, Jesus Guinea, Alessandro Limongelli, Antonella Lupetti, Marina Machado, Malgorzata Mikulska, Jon Salmanton-García, Ana Soriano-Martin, Lucia Taramasso, Maricela Valerio, Emilio Bouza, Patricia Muñoz, Matteo Bassetti

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Abstract

Background: This study assesses the impact of fluconazole resistance on 30-day all-cause mortality and 1-year recurrence in patients with Candida parapsilosis bloodstream infections (BSI).

Methods: A multicenter retrospective study was performed at 3 hospitals in Italy and Spain between 2018 and 2022. Adult patients with positive blood cultures for C. parapsilosis who received appropriate targeted therapy with either echinocandins or fluconazole were included.

Results: Among 457 patients, 196 (42.9%) had fluconazole-resistant C. parapsilosis (FLZR-CP) BSI and 261 (57.1%) had fluconazole-susceptible C. parapsilosis (FLZS-CP) BSI. All FLZR-CP patients received targeted echinocandins, while FLZS-CP patients received either echinocandins (60.5%) or fluconazole (39.5%). Unadjusted 30-day all-cause mortality rates were 28.6% for FLZR-CP and 28.4% for FLZS-CP (log-rank test, P = .998). In multivariable analysis, increased mortality was associated with age (adjusted hazard ratio [aHR] 1.03 per year; 95% confidence interval [CI], 1.01-1.05; P = .0005), solid tumor (aHR 1.91; 95% CI, 1.06-3.46; P = .0302), previous antifungal treatment (aHR 1.84; 95% CI, 1.12-3.10; P = .0192), and septic shock (aHR 2.39; 95% CI, 1.42-4.06; P = .0010), but not fluconazole resistance (aHR 1.00; 95% CI, .62-1.63; P = .9864) nor the type of initial antifungal therapy (aHR 1.46; 95% CI, .69-3.06; P = .3202). Propensity score-matched analysis showed no 30-day all-cause mortality difference between echinocandin-treated FLZR-CP and fluconazole-treated FLZS-CP patients (HR 0.81; 95% CI, .37-1.75; P = .5915). However, a higher 1-year recurrence risk was observed in FLZR-CP patients (odds ratio, 7.37; 95% CI, 2.11-25.80; P = .0018).

Conclusions: Our results suggest that fluconazole resistance is not associated with a higher mortality risk in patients with C. parapsilosis BSI, though 1-year recurrence rates were higher in the FLZR-CP group.

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氟康唑耐药对准假丝酵母血液感染患者预后的影响：一项回顾性多中心研究

背景：本研究评估氟康唑耐药对准假丝酵母血液感染（BSI）患者30天全因死亡率和1年复发率的影响。方法：2018 - 2022年在意大利和西班牙的3家医院进行多中心回顾性研究。本研究纳入了血培养呈阳性、接受棘球白菌素或氟康唑适当靶向治疗的旁裂梭菌病成年患者。结果：457例患者中，有196例（42.9%）为氟康唑耐药型假丝胞菌（FLZR-CP） BSI， 261例（57.1%）为氟康唑敏感型假丝胞菌（FLZS-CP） BSI。所有FLZR-CP患者均接受靶向棘白菌素治疗，而FLZS-CP患者接受棘白菌素（60.5%）或氟康唑（39.5%）治疗。FLZR-CP未调整的30天全因死亡率为28.6%，FLZS-CP为28.4% （log-rank检验，P = .998）。在多变量分析中，死亡率的增加与年龄相关(校正风险比[aHR] 1.03 /年；95%置信区间[CI]， 1.01-1.05；P = 0.0005)，实体瘤(aHR 1.91；95% ci, 1.06-3.46；P = 0.0302)，既往抗真菌治疗(aHR 1.84；95% ci, 1.12-3.10；P = 0.0192)，感染性休克(aHR 2.39；95% ci, 1.42-4.06；P = 0.0010)，但氟康唑耐药性无统计学意义(aHR 1.00；95% ci, 0.62 -1.63；P = .9864)和初始抗真菌治疗类型(aHR 1.46；95% ci, 0.69 -3.06；P = .3202)。倾向评分匹配分析显示，棘白素治疗的FLZR-CP患者与氟康唑治疗的FLZS-CP患者30天全因死亡率无差异(HR 0.81；95% ci, 0.37 -1.75；P = .5915)。然而，FLZR-CP患者1年复发风险较高(优势比，7.37；95% ci, 2.11-25.80；P = .0018)。结论：我们的研究结果表明氟康唑耐药与镰状弓形虫BSI患者较高的死亡风险无关，尽管FLZR-CP组的1年复发率较高。

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.