BACKGROUND Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. METHODS A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. RESULTS A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08-1.57); P = 0.005). The median length of ICU stay was 29 days [range 12-49 days] in the antifungal-resistant group and 18 days [range 6.7-37.5 days] in the antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21-138 days] in the antifungal-resistant group and 35 days [range 17-77 days] in the antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84-1.21); P = 0.89). CONCLUSIONS Our results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding.

中文翻译：

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念珠菌血症患者的抗真菌药耐药性：一项回顾性队列研究。

背景技术念珠菌血症是侵袭性念珠菌病的最常见形式。耐药性念珠菌血流感染（BSI）正在上升，限制了全球范围内广谱抗真菌药的开发。我们的研究旨在确定抗真菌抗性念珠菌血症的发生和这些物种的分布，确定与抗真菌抗性有关的危险因素，并评估抗真菌抗性念珠菌血症与重症监护病房（ICU）的长度和住院时间以及30天的死亡率。方法在沙特阿拉伯吉达的费萨尔国王专科医院和研究中心进行了一项回顾性队列研究。纳入了2006年1月至2017年12月诊断为念珠菌血症的成年患者。结果在94例男性（占49.74％）和95例女性（占50个）中共发现196个BSI。26％）。光滑念珠菌是最常见的念珠菌，有59个（30％），其次是白色念珠菌（46个（23％））。现有122/189名患者的药敏数据，其中26/122名患者（21％）对一种或多种抗真菌药耐药。在30/122个分离物中发现了具有可利用的敏感度数据的副枝梭菌，其中10/30（33％）对氟康唑有抗药性。与抗真菌抗性念珠菌血症显着相关的危险因素包括先前棘皮菌素暴露（几率（OR）= 1.38； 95％置信区间（CI）（1.02-1.85）； P = 0.006）和有创通气（OR = 1.3； 95％CI （1.08-1.57）； P = 0.005）。抗真菌药耐药组中ICU住院的中位时间为29天（12-49天），抗真菌药敏感组为18天（6.7-37.5天）（P = 0.28）。抗真菌药耐药组的中位住院时间为51天[21-138天]，抗真菌药敏感组为35天[17-77天]（P = 0.09）。抗真菌药耐药组和抗真菌药敏感组的30天死亡率分别为15（57.7％）和54（56.25％）（OR = 1.01; 95％CI（0.84-1.21）; P = 0.89）。结论我们的结果表明非白色念珠菌念珠菌血症频率很高。副纤毛虫对氟康唑的耐药性上升令人震惊。需要进一步的研究以证实这一发现。结论我们的结果表明非白色念珠菌念珠菌血症频率很高。副纤毛虫对氟康唑的耐药性上升令人震惊。需要进一步的研究以证实这一发现。结论我们的结果表明非白色念珠菌念珠菌血症频率很高。副纤毛虫对氟康唑的耐药性上升令人震惊。需要进一步的研究以证实这一发现。