636. Distribution of Candida Species and Factors Associated with Unfavorable Response to Candida Non-Albicans Infection in Hospitalized Patients with Invasive Candidiasis
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: The prevalence of non-albicans Candida species and resistance to fluconazole therapy has been on rise. The objectives of our study were to determine the distribution of Candida species and factors associated with non-response to treatment of invasive Candida non-albicans infection.

Methods: Medical charts were reviewed for hospitalized patients in the US who received IV anti-fungal drugs for invasive candidiasis between January 1, 2005 and June 30, 2007. Patients with Candida species isolated from blood, CSF fluid, abdomen/peritoneum, cardiac, catheter site, and surgical site culture were included in the analysis. Clinical outcomes to antifungal therapy was assessed in terms of favorable (complete and partial resolution) versus unfavorable (no resolution and worsening of infection) response. A stepwise multivariate logistic regression was used, with p-values <0.10 and < 0.05 as the criteria of entering and being retained in the model respectively.

Results: Candida species were isolated from 183 patients. The most commonly identified species was C. albicans (92, 50.3%) followed by C. glabrata (49, 26.8%), C. tropicalis (26, 14.2%), C. parapsilosis (22, 12.0%), and C. krusei (3, 1.6%). Multiple Candida species were isolated in 13 patients (7.1%). Among 100 patients with Candida non-albicans infection, 20 patients received only fluconazole (unfavorable clinical response rate = 50%) and the remaining 80 patients received other antifungal drugs, with or without fluconazole (unfavorable clinical response rate = 26.6%). Multivariate analysis identified ICU admission (OR =4.23; 95% CI: 1.62-11.07; p = 0.003) and antifungal treatment with fluconazole only (OR =3.41; 95% CI: 1.14-10.19; p = 0.03) as independent determinants of unfavorable response to treatment of Candida non-albicans infection.

Conclusion: Candida non-albicans was isolated from more than half the number of patients with invasive candidiasis.  C. glabrata was the most common non-albicans species. Although there was not sufficient information to fully understand difference between treatment groups, our findings suggest that treatment of invasive Candida non-albicans infection with fluconazole alone may lead to lower favorable clinical response rates.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Girish D. Prajapati, M.B.B.S., MPH , Pharmacy Practice and Administration, Global Health Outcomes, Rutgers The State University, Merck & Co., Inc., Whitehouse Station, NJ
Ritesh Kumar, Ph.D. , Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ
Larry Ma, Ph.D. , Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ

Disclosures:

G. D. Prajapati, None

R. Kumar, None

L. Ma, None

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