Introduction. Resistance rates to azoles and echinocandins of Candida spp. increased over the last decade. Hypothesis/Gap Statement. Widespread use of antifungals could lead to development and dissemination of resistant Candida spp. Aim. To identify risk factors for isolation of Candida spp. non-susceptible to either fluconazole or echinocandins. Methodology. All patients hospitalized in the Intensive Care Unit (ICU) of the University General Hospital of Patras, Greece with Candida spp. isolated from clinical specimens during a ten-year period (2010–19) were included. Candida isolates were identified using Vitek-2 YST card. Consumption of antifungals was calculated. Results. During the study period, 253 isolates were included. C. non-albicans predominated (64.4 %) with C. parapsilosis being the most commonly isolated (42.3 %) followed by C. glabrata (nomenclatural change to Nakaseomyces glabrataa; 8.7 %) and C. tropicalis (11.9 %). Among all isolates, 45.8 and 28.5 % were non-susceptible and resistant to fluconazole, respectively. Concerning echinocandins, 8.7 % of isolates were non-susceptible to at least one echinocandin (anidulafungin or micafungin) and 3.1 % resistant. Multivariate analysis revealed that hospitalization during 2015–19, as compared to 2010–14, isolate being non-albicans or non-susceptible to at least one echinocandin was associated with isolation of fluconazole non-susceptible isolate. Administration of echinocandin, isolate being C. glabrata or C. tropicalis, or Candida spp. non-susceptible to fluconazole were independently associated with isolation of Candida spp. non-susceptible to at least one echinocandin. Fluconazole’s administration decreased during the study period, whereas liposomal-amphotericin B’s and echinoncandins’ administration remained stable. Conclusion. Fluconazole’s non-susceptibility increased during the study period, despite the decrease of its administration. Although echinocandins’ administration remained stable, non-susceptibility among Candida spp. increased.

中文翻译：

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危重患者分离氟康唑和棘白菌素非敏感念珠菌的危险因素

介绍。念珠菌对唑类和棘白菌素的耐药率。在过去十年中有所增加。假设/差距陈述。抗真菌剂的广泛使用可能导致耐药念珠菌的发展和传播。目的。确定分离念珠菌的危险因素。对氟康唑或棘白菌素不敏感。方法。所有在希腊帕特雷大学总医院重症监护室 (ICU) 住院的念珠菌患者。包括在十年期间（2010-19）从临床标本中分离出来的。念珠菌使用 Vitek-2 YST 卡鉴定分离株。计算抗真菌剂的消耗量。结果。在研究期间，包括 253 个分离株。Ç。非白色念珠菌占主导地位 (64.4 %)，近平滑念珠菌是最常分离的 (42.3 %)，其次是光滑念珠菌（命名变化为光滑中丝酵母；8.7 %）和热带念珠菌(11.9%)。在所有分离株中，分别有 45.8% 和 28.5% 对氟康唑不敏感和耐药。关于棘白菌素，8.7% 的分离株对至少一种棘白菌素（阿尼拉芬净或米卡芬净）不敏感，3.1% 耐药。多变量分析显示，与 2010-14 年相比，2015-19 年住院期间，非白色念珠菌或对至少一种棘白菌素不敏感的分离株与氟康唑非敏感分离株的分离有关。棘白菌素的施用，分离物为光滑念珠菌或热带念珠菌，或念珠菌属。对氟康唑不敏感与念珠菌分离独立相关属 对至少一种棘白菌素不敏感。在研究期间氟康唑的给药量减少，而脂质体-两性霉素 B 和棘白菌素的给药量保持稳定。结论。尽管减少了给药量，但在研究期间氟康唑的非敏感性增加了。尽管棘白菌素的给药保持稳定，但在念珠菌属中不敏感。增加。