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Diagn Microbiol Infect Dis. 2018 Oct;92(2):127-132. doi: 10.1016/j.diagmicrobio.2018.05.001. Epub 2018 Jun 19.

Impact of high MIC of fluconazole on outcomes of Candida glabrata bloodstream infection: a retrospective multicenter cohort study.

Author information

1
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: krpeck@skku.edu.
3
Division of Infectious Diseases, Dong-A University College of Medicine, Busan, Korea.
4
Division of Infectious Diseases, Keimyung University Dongsan Medical Center, Daegu, Korea.
5
Division of Infectious Diseases, Chonnam National University Hospital, Gwangju, Korea.
6
Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
7
Division of Infectious Diseases, Chungnam National University School of Medicine, Daejeon, Korea.
8
Division of Infectious Diseases, Kyungpook National University School of Medicine, Daegu, Korea.
9
Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

To evaluate the impacts of fluconazole minimum inhibitory concentration (MIC) according to primary antifungal agents on Candida glabrata bloodstream infection (BSI), a multicenter retrospective cohort study was conducted in Korea, concerning the time period from January 2010 to February 2016. A total of 197 adult patients with C. glabrata BSI were included in the study, and neutropenia (P = 0.026), APACHE II score (P = 0.004), and fluconazole resistance (HR 3.960, 95% CI 1.395-11.246, P = 0.010) were associated with 30-day mortality in multivariate analysis. In subgroup analysis, fluconazole MIC = 32 μg/mL in the azole-treated group (HR 6.691, 95% CI 1.569-28.542, P = 0.010) and fluconazole MIC ≥ 64 μg/mL in the non-azole-treated group (HR 3.337, 95% CI 1.183-9.411, P = 0.023) showed the highest hazard ratio (HR) for 30-day mortality. Increased fluconazole MIC was associated with poor outcome both in azole- and non-azole-treated patients with C. glabrata BSI.

KEYWORDS:

Candida glabrata; amphotericin; echinocandin; fluconazole; minimum inhibitory concentration

[Indexed for MEDLINE]

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