The effect of cumulative length of hospital stay on the antifungal resistance of Candida strains isolated from critically ill surgical patients

Mycopathologia. 2011 Feb;171(2):85-91. doi: 10.1007/s11046-010-9369-3. Epub 2010 Oct 8.

Abstract

Fluconazole is the first line of therapy for the management of candidiasis. However, fluconazole-resistant strains pose an emerging challenge in everyday clinical practice. In this study, we sought to determine whether cumulative length of hospital stay (CLOS) is a predictive factor for the acquisition of non-susceptible Candida strains to fluconazole. Thirty-three critically ill emergency surgery patients with 56 Candida isolates were enrolled in this prospective study. We divided our isolates according to their minimum inhibitory concentration (MIC) to fluconazole using 8 mcg/ml as a cutoff. We then compared the two groups with respect to basic demographics, antifungal agents prescribed, number of wide-spectrum antibiotics, duration of central venous catheter placement, elapsed time to positive culture, duration of prior hospital stay, and length of hospital stay. Non-susceptible fluconazole samples belonged to patients with a significantly longer prior hospital stay and a longer CLOS (P = 0.02 and 0.01, respectively). The difference between the 2 groups regarding non-albicans strains was statistically significant (P < 0.001). By fitting a non-parametric receiver-operating characteristics (ROC) curve into our analysis, a CLOS ≥ 29 days predicted the occurrence of non-susceptible strains with 90% sensitivity and 79.6% specificity (correct classification 81.5%). A CLOS ≥ 29 days is a strong predictor for the isolation of non-susceptible Candida isolates to fluconazole among critically ill emergency surgery patients. Clinicians should consider the duration of previous hospital stay when deciding on empiric antifungal therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / pharmacology*
  • Candida / drug effects*
  • Candida / isolation & purification*
  • Candidiasis / microbiology*
  • Critical Illness
  • Drug Resistance, Fungal*
  • Fluconazole / pharmacology*
  • Hospitals
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Prospective Studies
  • ROC Curve

Substances

  • Antifungal Agents
  • Fluconazole