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A multicenter retrospective analysis of the antifungal susceptibility patterns of Candida species and the predictive factors of mortality in South Korean patients with candidemia

Authors
 In Young Jung  ;  Su Jin Jeong  ;  Young Keun Kim  ;  Hyo Youl Kim  ;  Young Goo Song  ;  June Myung Kim  ;  Jun Yong Choi 
Citation
 MEDICINE, Vol.99(11) : e19494, 2020-03 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2020-03
MeSH
Aged ; Antifungal Agents / pharmacology ; Antifungal Agents / therapeutic use* ; Candida / drug effects* ; Candidemia / drug therapy* ; Candidemia / mortality ; Drug Resistance, Fungal* ; Female ; Fluconazole / pharmacology ; Fluconazole / therapeutic use* ; Humans ; Male ; Microbial Sensitivity Tests ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Factors
Abstract
As detection rates of non-albicans Candida species are increasing, determining their pathogen profiles and antifungal susceptibilities is important for antifungal treatment selection. We identified the antifungal susceptibility patterns and predictive factors for mortality in candidemia.A multicenter retrospective analysis of patients with at least 1 blood culture positive for Candida species was conducted. Candida species were classified into 3 groups (group A, Candia albicans; group B, Candida tropicalis, and Candida parasilosis; group C, Candida glabrata and Candida krusei ) to analyze the susceptibility patterns, first-line antifungal administered, and mortality. Univariate and multivariate comparisons between outcomes were performed to identify mortality risk factors.In total, 317 patients were identified, and 136 (42.9%) had recorded mortality. Echinocandin susceptibility was higher for group A than group B (111/111 [100%] vs 77/94 [81.9%], P < .001). Moreover, group A demonstrated higher fluconazole susceptibility (144/149 [96.6%] vs 39/55 [70.9%], P < .001) and lower mortality (68 [45.3%] vs 34 [61.8%], P = .036) than those of group C. In the multivariate analysis, the sequential organ failure assessment score (odds ratio OR 1.351, 95% confidence interval 1.067-1.711, p = 0.013) and positive blood culture on day 7 of hospitalization (odds ratio 5.506, 95% confidence interval, 1.697-17.860, P = .004) were associated with a higher risk of mortality.Patients with higher sequential organ failure assessment scores and sustained positive blood cultures have an increased risk of mortality.
Files in This Item:
T202002003.pdf Download
DOI
10.1097/MD.0000000000019494
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, June Myung(김준명)
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179028
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