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

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 BSIwere 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 associatedwith 30-daymortality inmultivariate 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-daymortality. Increased fluconazoleMIC was associated with poor outcome both in azole- and non-azole-treated patients with C. glabrata BSI.