Risk factors for isolation of fluconazole and echinocandin non-susceptible species in critically ill patients.

Resistance rates to azoles and echinocandins of spp. increased over the last decade. Widespread use of antifungals could lead to development and dissemination of resistant spp. To identify risk factors for isolation of spp. non-susceptible to either fluconazole or echinocandins. All patients hospitalized in the Intensive Care Unit (ICU) of the University General Hospital of Patras, Greece with spp. isolated from clinical specimens during a ten-year period (2010-19) were included. isolates were identified using Vitek-2 YST card. Consumption of antifungals was calculated. During the study period, 253 isolates were included. . non- predominated (64.4 %) with being the most commonly isolated (42.3 %) followed by (nomenclatural change to ; 8.7 %) and (11.9 %). Among all isolates, 45.8 and 28.5 % were non-susceptible and resistant to fluconazole, respectively. Concerning echinocandins, 8.7 % of isolates were non-susceptible to at least one echinocandin (anidulafungin or micafungin) and 3.1 % resistant. Multivariate analysis revealed that hospitalization during 2015-19, as compared to 2010-14, isolate being non- or non-susceptible to at least one echinocandin was associated with isolation of fluconazole non-susceptible isolate. Administration of echinocandin, isolate being or , or spp. non-susceptible to fluconazole were independently associated with isolation of spp. non-susceptible to at least one echinocandin. Fluconazole's administration decreased during the study period, whereas liposomal-amphotericin B's and echinoncandins' administration remained stable. Fluconazole's non-susceptibility increased during the study period, despite the decrease of its administration. Although echinocandins' administration remained stable, non-susceptibility among spp. increased.