Risk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: An analysis from the China Survey of Candidiasis study.

PURPOSE To assess the risk factors for invasive Candida infection (ICI) caused by fluconazole-resistant (Flu-R) Candida species in intensive care unit (ICU) patients. MATERIALS AND METHODS Data from China Survey of Candidiasis study were analyzed. Patients with proven ICI were classified into fluconazole-sensitive (Flu-S) and Flu-R groups. Independent risk factors for Flu-R ICI were identified using a multivariate logistic regression. RESULTS Forty-one percent of ICI patients were infected with Flu-R Candida. Significantly more patients had Candida colonization, intra-abdominal hypertension, and antifungal therapy at least 7 days before diagnosis; fewer patients had gastrointestinal perforation, systemic inflammatory response syndrome manifestation, and fluoroquinolone exposure in the Flu-R group. Furthermore, hospital or ICU stay before onset of infection was longer in the Flu-R group than in the Flu-S group (hospital or ICU stay: 19 vs 13 days or 10.5 vs 8 days, P < .05). Also, it was demonstrated as an independent risk factor for Flu-R Candida infection. CONCLUSION As many as 41% of ICI patients were infected with Flu-R Candida, and the main risk factor was longer ICU stay before onset of ICI, implying that caution should be exercised when treating patients who have been long stayed in ICU with fluconazole as the first-line drug before testing isolates for drug sensitivity.