Beschreibung:
<jats:p><jats:bold>Background:</jats:bold><jats:italic>Candida</jats:italic> spp can cause a variety of infections known as candidiasis, ranging from severe invasive infections to superficial mucosal infections of the mouth and vagina. Fluconazole, a triazole antifungal, is commonly prescribed to treat candidiasis but increasing fluconazole resistance is a growing concern for several <jats:italic>Candida</jats:italic> spp. Although <jats:italic>C. albicans</jats:italic> has historically been the most common cause of candidiasis, other species are increasingly common and antifungal resistance is more prevalent in these non-<jats:italic>albicans</jats:italic> species, including <jats:italic>C. glabrata</jats:italic>, <jats:italic>C. parapsilosis</jats:italic>, and <jats:italic>C. tropicalis</jats:italic>, which were the focus of this analysis. <jats:bold>Methods:</jats:bold> We used the PINC AI healthcare data (PHD) database to examine fluconazole resistance for inpatient isolates between 2012 and 2021 from 187 US acute-care hospitals with at least 1 <jats:italic>Candida</jats:italic> spp culture with a fluconazole susceptibility result over the entire period. We calculated annual percentage fluconazole resistance for <jats:italic>C. glabrata</jats:italic>, <jats:italic>C. tropicalis</jats:italic>, and <jats:italic>C. parapsilosis</jats:italic> isolates using the clinical laboratory interpretation for resistance. <jats:bold>Results:</jats:bold> We identified 4,264 <jats:italic>C. glabrata</jats:italic>, 2,482 <jats:italic>C. parapsilosis</jats:italic>, and 2,283 <jats:italic>C. tropicalis</jats:italic> isolates between 2012 and 2021 with susceptibility results. The percentage of <jats:italic>C. glabrata</jats:italic> isolates resistant to fluconazole doubled between 2020 and 2021 (14.6% vs 29.3%) (Fig. 1a). The percentage of <jats:italic>C. parapsilosis</jats:italic> isolates resistant to fluconazole steadily increased since 2017 (Fig. 1b), with an 82% increase in 2021 compared with 2020 (3.8% in 2020 vs 6.9% in 2021). Fluconazole resistance among <jats:italic>C. tropicalis</jats:italic> isolates varied over the years, with a 0.3% decrease in 2021 from 2020 (Fig. 1c). Of hospitals reporting at least 1 result each year 2020–2021, 44% observed an increase in the proportion of <jats:italic>C. glabrata</jats:italic> isolates resistant to fluconazole in 2021 compared to 2020. <jats:bold>Conclusions:</jats:bold> Our analysis highlights a concerning increase in fluconazole resistance among <jats:italic>C. glabrata</jats:italic> and <jats:italic>C. parapsilosis</jats:italic> isolates in 2021 compared with previous years. Further investigation of the observed increases in fluconazole resistance among these <jats:italic>Candida</jats:italic> spp could provide further insight on potential drivers of resistance or limitations in reported results from large databases. More analyses are needed to understand rates, sites of <jats:italic>Candida</jats:italic> infections, and risk factors (eg, antifungal exposure) associated with resistance.</jats:p><jats:p><jats:fig position="float"><jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" mime-subtype="png" mimetype="image" position="float" xlink:href="S2732494X23002553_fig1.png" /></jats:fig></jats:p><jats:p><jats:bold>Disclosures:</jats:bold> None</jats:p>