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Volume 31, Number 10—October 2025

CME ACTIVITY - Research

Recent Systemic Antifungal Exposure and Nonsusceptible Candida in Hospitalized Patients, South Africa, 2012–2017

Charlotte Rabault, Liliwe Shuping, Ruth Mpembe, Vanessa Quan, Fanny Lanternier, Olivier Lortholary, Olivier Paccoud, Nelesh P. GovenderComments to Author , and for GERMS-SA
Author affiliation: National Institute for Communicable Diseases, Johannesburg, South Africa (C. Rabault, L. Shuping, R. Mpembe, V. Quan, N.P. Govender); Hôpital Universitaire Necker-Enfants malades Service des Maladies Infectieuses et Tropicales Adultes, Paris, France (C. Rabault, F. Lanternier, O. Lortholary, O. Paccoud); Institut Pasteur, Paris (F. Lanternier, O. Lortholary); Université Paris Cité, Paris (F. Lanternier, O. Lortholary ,O. Paccoud); University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg (N.P. Govender); University of Cape Town Faculty of Health Sciences, Western Cape, South Africa (N.P. Govender); University of Exeter MRC Centre for Medical Mycology, Exeter, UK (N.P. Govender)

Main Article

Table 2

Random-effect multivariable logistic regression analysis of the effect of prior exposure to antifungal drugs on nonsusceptible Candida bloodstream infections among patients with culture-confirmed candidemia, South Africa, 2012–2017*

Variable <90 d of age†
 >90 days of age‡
Summary aOR (95% CI) for nonsusceptible Candida spp. Wald p value Summary aOR (95% CI) for nonsusceptible Candida spp. Wald p value
Prior antifungal exposure
No Referent Referent
Yes
 1.06 (0.75–1.49)
 0.73
2.02 (1.43–2.87)
 <0.001
Age group
Neonates, <28 d Referent NA
Young infants, 29 d–90 d 0.79 (0.53–1.16) 0.23 NA
Older infants, >90 d–1 y NA Referent
Children–adolescents, >1 y–17 y NA 0.95 (0.58–1.56) 0.84
Adults, 18 y–64 y NA 1.92 (1.26–2.91) 0.002
Elderly, >65 y
 NA-
2.84 (1.70–4.74)
 <0.001
Sex
F Referent Referent
M
 1.11 (0.84–1.47)
 0.36
1.03 (0.81–1.32)
 0.47
Year 0.02
2012–2013 Referent Referent
2014–2015 1.97 (1.15–3.38) 0.01 1.06 (0.71–1.58) 0.77
2016 1.47 (0.92–2.32) 0.1 1.65 (1.18–2.32) 0.004
2017
 1.82 (1.16–2.84)
 0.009
1.49 (1.07–2.08)
 0.02
Province
Other Referent Referent
Gauteng
 2.93 (1.21–7.14)
 0.01
1.64 (1.25–2.14)
 <0.001
ICU admission
No NA Referent
Yes
 NA
1.95 (1.51–2.54)
 <0.001
Healthcare sector
Private NA Referent
Public
 NA
0.36 (0.21–0.60)
 <0.001
Hospital stay before infection onset, d
<2 Referent Referent
3–7 1.47 (0.78–2.80) 0.24 0.71 (0.47–1.05) 0.09
8–14 1.86 (1.06–3.28) 0.03 0.77 (0.53–1.13) 0.19
15–21 2.41 (1.33–4.39) 0.004 0.79 (0.51–1.23) 0.29
>22
 2.53 (1.38–4.64)
 0.003
0.98 (0.69–1.40)
 0.90
Type of delivery
Cesarean section Referent NA
Vaginal delivery
 0.75 (0.56–1.00)
 0.05
NA
Birthweight 0.02
NBW, >2,500 g Referent NA
LBW, <2,500 g 1.32 (0.86–2.02) 0.21 NA
VLBW, <1,500 g 1.49 (0.98–2.26) 0.06 NA
ELBW, <1,000 g 1.82 (1.11–2.97) 0.018 NA

*aOR, adjusted odds ratio; ELBW, extremely low birthweight; ICU, intensive care unit; LBW, low birthweight; NA, not applicable; NBW, normal birthweight; VLBW, very low birthweight. †23 clusters, mean observations per group = 42.3 (range 1–296); intracluster correlation coefficient = 0.14; p<0.001. ‡31 clusters, mean observations per group = 42.5 (range 1–166); intracluster correlation coefficient <0.0001; p = 0.5.

Main Article

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