Previous studies have sought to determine the risk factors associated with
candidemia caused by non-albicans Candida spp. or with potentially
fluconazole-resistant Candida spp. (C. glabrata and C. krusei). Non-albicans Candida strains are a heterogeneous group that includes species with different levels of virulence, and only a limited number of C. glabrata isolates are resistant to
fluconazole. We set out to identify the risk factors associated with microbiologically proven
fluconazole-resistant
candidemia. A prospective study including adult patients with
candidemia was performed. Data were collected on patient demographics; underlying diseases; exposure to
corticosteroids,
antibiotics, or
fluconazole; and invasive procedures. Risk factors associated either with non-albicans Candida spp. or potentially
fluconazole-resistant Candida spp. (C. glabrata or C. krusei) or with Candida spp. with microbiologically confirmed
fluconazole resistance were assessed using logistic regressions. We included 226
candidemia episodes. Non-albicans Candida isolates accounted for 53.1% of the fungal isolates, but only 18.2% of the cases were caused by potentially
fluconazole-resistant organisms. Thirty isolates exhibited microbiologically confirmed
fluconazole resistance. The multivariate analysis revealed that independent predictors associated with
fluconazole-resistant Candida spp. were
neutropenia (odds ratio [OR]=4.94; 95% confidence interval [CI]=1.50 to 16.20; P=0.008),
chronic renal disease (OR=4.82; 95% CI=1.47 to 15.88; P=0.01), and previous
fluconazole exposure (OR=5.09; 95% CI=1.66 to 15.6; P=0.004). Independently significant variables associated with non-albicans Candida
bloodstream infection or with potentially
fluconazole-resistant Candida spp. did not include previous
fluconazole exposure. We concluded that prior
fluconazole treatment is an independent risk factor only for
candidemia caused by microbiologically confirmed
fluconazole resistant species. Our findings may be of value for selecting empirical antifungal
therapy.