Volume 25, Number 9—September 2019
Research
Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017
, and Shan-Chwen Chang
Table 2
Comparisons of clinical and microbiological characteristics between fluconazole-susceptible and fluconazole-nonsusceptible Candida tropicalis bloodstream infections, Taiwan, 2011–2017*
| Characteristic | Total, n = 344 | With FS C. tropicalis BSIs, n = 286 | With FNS C. tropicalis BSIs, n = 58 | p value |
|---|---|---|---|---|
| Demographics | ||||
| Age, y, median (IQR) | 62.8 (53.2–73.5) | 62.4 (53.0–74.3) | 63.4 (55.2–72.1) | 0.85 |
| Sex, no. (%) | 0.54 | |||
| M | 201 (58.4) | 165 (57.7) | 36 (62.1) | |
| F |
143 (41.6) |
121 (42.3) |
22 (37.9) |
|
| Disease severity | ||||
| ICU onset, no. (%) | 105 (30.7) | 85 (29.9) | 20 (34.5) | 0.49 |
| APACHE II score, median (IQR) |
20.0 (15.0–26.0) |
20.0 (15.0–26.0) |
19.0 (15.5–26.0) |
0.85 |
| Healthcare factors, no. (%)† | ||||
| Solid organ transplant | 4 (1.2) | 3 (1.1) | 1 (1.8) | 0.52 |
| Hematopoietic stem cell transplant | 10 (2.9) | 9 (3.2) | 1 (1.8) | 0.99 |
| Major surgery | 40 (11.6) | 34 (11.9) | 6 (10.3) | 0.99 |
| Parenteral hyperalimentation | 189 (59.4) | 155 (54.2) | 34 (58.6) | 0.54 |
| Steroid use | 170 (49.4) | 133 (46.5) | 37 (63.8) | 0.02 |
| Chemotherapy | 153 (44.5) | 123 (43.0) | 30 (51.7) | 0.22 |
| Neutropenia | 91 (26.8) | 69 (24.5) | 22 (38.6) | 0.03 |
| Mechanical ventilator | 101 (29.4) | 84 (29.4) | 17 (29.3) | 0.99 |
| Indwelling urinary catheter | 138 (40.1) | 110 (38.5) | 28 (48.3) | 0.16 |
| Central venous catheter | 286 (83.1) | 238 (83.2) | 48 (82.8) | 0.93 |
| Antifungal exposure | 60 (17.4) | 34 (11.9) | 26 (44.8) | <0.001 |
| Antibiotics exposure |
300 (87.7) |
248 (87.3) |
52 (89.7) |
0.62 |
| Therapeutic intervention, no. (%)‡ | ||||
| Early appropriate antifungal agents | 261 (75.9) | 243 (85.0) | 18 (31.0) | <0.001 |
| Fluconazole as the first antifungal agent | 221 (64.2) | 185 (64.7) | 36 (62.1) | 0.71 |
| Early removal of central venous catheter |
162/286 (56.6) |
131/238 (55.0) |
31/48 (64.6) |
0.22 |
| Clinical outcomes, no. (%) | ||||
| Death | ||||
| 7 d | 73 (21.2) | 60 (21.0) | 13 (22.4) | 0.81 |
| 14 d | 117 (34.0) | 99 (34.6) | 18 (31.0) | 0.60 |
| 28 d | 167 (48.6) | 141 (49.3) | 26 (44.8) | 0.53 |
| In hospital | 226 (65.7) | 187 (65.4) | 39 (67.2) | 0.79 |
| Persistence, no. (%)§ | 81 (27.7) | 65 (26.6) | 16 (33.3) | 0.34 |
*Additional information on patient conditions and microbiological data can be found in Appendix Table 3 (https://wwwnc.cdc.gov/EID/article/25/9/19-0520-App1.pdf). APACHE, Acute Physiology and Chronic Health Evaluation; BSIs, bloodstream infections; FNS, fluconazole nonsusceptible; FS, fluconazole susceptible; ICU, intensive care unit; IQR, interquartile range.
†Major surgery refers to cardiovascular or abdominal surgery. Classes of antifungal exposure to azole or echinocandin, 31/3 in FS group vs. 24/2 in FNS group; of note, 14 (24.1%) patients in the FNS group experienced breakthrough bloodstream infections, compared with 18 (6.3%) patients in the FS group (p<0.001).
‡Early adequate antifungal agents refers to administration of the recommended dose of an intravenous antifungal agent within 48 h after first positive blood culture collection for a susceptible Candida isolate, according to the Clinical and Laboratory Standards Institute (CLSI) species-specific breakpoints (14). Early removal of central venous catheters is defined as removal of all similar devices, including tunneled and peripherally inserted central catheters, within 48 h after obtaining the first positive blood culture.
§Persistence is defined as >5 days of blood cultures positive for the same Candida species.