A Prospective Observational Study of Risk Factors for Candida glabrata in an SICU: Role of Fluconazole

Abstract

Background Candida glabrata has emerged as a serious nosocomial pathogen, particularly in surgical intensive care units (SICU). Purpose To determine potential risk factors for the emergence of C. glabrata colonization or infection (C/I) in the SICU. Methods A prospective observational study was conducted collecting and analyzing variables associated with the development of C/I with C. glabrata versus non- glabrata Candida species in our SICU. Results Fourteen patients developed C/I with C. glabrata (cases), while 21 patients developed C/I with non- glabrata Candida species (controls). Univariate analyses identified the following continuous variables as being statistically significant for the development of C/I with C. glabrata: number of days prior to antifungal or penicillin class therapy. The following categorical variables were significant by univariate analyses: any prior use of piperacillin/tazobactam, penicillin class, or fluconazole, or at least 5 days of use of fluconazole. Any prior use of levofloxacin was found to be statistically significant for controls. Multivariate-logistic regression analysis identified more than 5 days of fluconazole use and no prior use of levofloxacin as independent risk factors for the development of C. glabrata C/I in the SICU. Conclusions Prior fluconazole use was identified as an independent risk factor for development of C. glabrata C/I.