Table 4.
Risk factors associated with fluconazole-nonsusceptible Candida species from HSCT and SOT recipients after bivariate analysis
| Transplant type and characteristic |
n (%) |
OR (95% CI) | P value | |
|---|---|---|---|---|
| Susceptiblea | Not susceptibleb | |||
| HSCT | ||||
| Median age, yr (range) | 44 (1-69) | 45 (10-72) | 1.24 (0.58-2.65) | 0.576 |
| Female | 33 (51) | 22 (48) | 0.89 (0.42-1.89) | 0.760 |
| Caucasian | 52 (80) | 38 (83) | 1.19 (0.45-3.15) | 0.730 |
| Hispanic | 12 (19) | 3 (7) | 0.30 (0.08-1.14) | 0.076 |
| 3-mo mortality | 34 (52) | 29 (63) | 1.56 (0.72-3.37) | 0.262 |
| Underlying diseases and comorbid conditions | ||||
| Non-Hodgkin's lymphoma | 8 (12) | 12 (26) | 2.52 (0.93-6.77) | 0.068 |
| Multiple myeloma | 9 (14) | 1 (2) | 0.14 (0.02-1.13) | 0.065 |
| CMV antigenemia | 8 (12) | 13 (28) | 2.81 (1.05-7.48) | 0.039 |
| Diabetes, acquired since transplant | 8 (12) | 15 (33) | 3.45 (1.32-9.03) | 0.012 |
| Diabetes, active at time of IFI | 9 (14) | 17 (37) | 3.65 (1.45-9.19) | 0.006 |
| Candida species | ||||
| C. glabrata | 12 (18) | 28 (61) | 6.87 (2.90-16.27) | <0.001 |
| C. krusei | 2 (3) | 15 (33) | 15.24 (3.28-70.87) | <0.001 |
| Medications used in prior 3 mo | ||||
| Inhaled amphotericin B | 2 (3) | 7 (15) | 5.65 (1.12-28.61) | 0.036 |
| Any amphotericin B | 12 (18) | 16 (35) | 2.36 (0.99-5.64) | 0.054 |
| Fluconazole | 22 (34) | 25 (54) | 2.33 (1.07-5.05) | 0.033 |
| Any antifungal prophylaxisc | 33 (51) | 36 (78) | 3.49 (1.49-8.19) | 0.004 |
| Granulocyte colony-stimulating factor | 21 (32) | 24 (52) | 2.29 (1.05-4.98) | 0.037 |
| Foscarnet | 5 (8) | 10 (22) | 3.33 (1.06-10.53) | 0.040 |
| SOT | ||||
| Median age, yr (range) | 49 (1-77) | 54 (2-80) | 1.42 (0.70-2.89) | 0.329 |
| Female | 73 (37) | 24 (65) | 3.14 (1.51-6.54) | 0.002 |
| Caucasian | 153 (77) | 32 (86) | 1.88 (0.69-5.11) | 0.215 |
| Hispanic | 11 (6) | 2 (5) | 0.97 (0.21-4.57) | 0.971 |
| 3-mo mortality | 55 (28) | 10 (29) | 1.03 (0.47-2.29) | 0.937 |
| Comorbid conditions/clinical presentation | ||||
| Diabetes, acquired since transplant | 36 (18) | 14 (38) | 2.74 (1.29-5.84) | 0.009 |
| Diabetes, active at time of IFI | 96 (48) | 13 (35) | 0.58 (0.28-1.20) | 0.138 |
| Hospitalized at time of IFI | 127 (64) | 31 (84) | 2.89 (1.15-7.26) | 0.024 |
| Mental status changes within 7 days of IFI | 16 (8) | 8 (22) | 3.14 (1.23-7.99) | 0.017 |
| Candida species | ||||
| C. albicans | 111 (56) | 3 (8) | 0.07 (0.02-0.23) | <0.001 |
| C. glabrata | 40 (20) | 21 (57) | 5.18 (2.48-10.84) | <0.001 |
| C. krusei | 4 (2) | 9 (24) | 15.59 (4.50-54.01) | <0.001 |
| Medications used in prior 3 mo | ||||
| Fluconazole | 45 (23) | 18 (49) | 3.22 (1.56-6.65) | 0.002 |
| Any itraconazole | 2 (1) | 3 (8) | 8.65 (1.40-53.68) | 0.021 |
| Any antifungal prophylaxis | 26 (13) | 13 (35) | 3.58 (1.63-7.90) | 0.002 |
| Granulocyte colony-stimulating factor | 8 (4) | 4 (11) | 2.88 (0.82-10.11) | 0.099 |
| Ganciclovir | 61 (31) | 20 (54) | 2.64 (1.30-5.39) | 0.008 |
a
n = 65 for HSCT; n = 198 for SOT.
b
n = 46 for HSCT; n = 37 for SOT.
c
Any antifungal prophylaxis includes fluconazole, itraconazole, voriconazole, posaconazole, ravuconazole, amphotericin B, caspofungin, micafungin, anidulafungin, ketoconazole, and flucytosine.