Clinical and economic outcomes of decreased fluconazole susceptibility in patients with Candida glabrata bloodstream infections
published online 14 June 2010. Corrected Proof
Background
The impact of reduced fluconazole susceptibility on clinical and economic outcomes in patients with Candida glabrata bloodstream infections (BSI) is unknown.
Methods
A retrospective cohort study was conducted to evaluate 30-day inpatient mortality and postculture hospital charges in patients with C glabrata BSI with decreased fluconazole susceptibility (minimum inhibitory concentration [MIC] ≥ 16 μg/mL) versus fluconazole-susceptible C glabrata BSI (MIC ≤ 8 μg/mL). These analyses were adjusted for demographics, comorbidities, and time at risk. Secondary analyses limited the C glabrata group with decreased fluconazole susceptibility to MIC ≥ 64 μg/mL.
Results
There were 45 (31%) deaths among 144 enrolled patients: 19 deaths (25%) among 76 patients with C glabrata BSI with decreased fluconazole susceptibility and 26 deaths (38%) among 68 patients with fluconazole-susceptible C glabrata BSI. Decreased fluconazole susceptibility was not independently associated with increased 30-day inpatient mortality (adjusted odds ratio, .60; 95% confidence interval (CI): 0.26-1.35; P = 0.22) or hospital charges (multiplicative change in hospital charges, .93; 95% CI: 0.60-1.43; P = 0.73). Older age was associated with increased mortality and increased time at risk was associated with increased hospital charges.
Conclusion
Crude mortality rates remain high in patients with C glabrata BSI. However, decreased fluconazole susceptibility was not associated with increased mortality or hospital charges.
aDivision of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
bCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
cCenter for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA
dDepartment of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
eDivision of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness of the Children's Hospital of Philadelphia, Philadelphia, PA
fDepartment of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
Address correspondence to Ingi Lee, MD, MSCE, Assistant Professor of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, 3400 Spruce St, Third Floor, Silverstein Building, Suite E, Philadelphia, PA 19104.
Conflicts of interest: Dr. Lautenbach received past grant support from Ortho-McNeil, Cubist, and AstraZeneca pharmaceuticals. Dr. Zaoutis received research grant support from Merck Pharmaceuticals. All other authors report no potential conflicts of interest.
Supported by a research grant from Merck Pharmaceuticals (to E.L.).
ABSTRACT