629. Study of Candidemia Outcomes and Risk Factors in Critically Ill A Retrospective Evaluation SCORE Study
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Candida Bloodstream Infections (BSI) are an important cause of mortality and morbidity in critically ill patients.  Candida Glabrata (CG) has emerged as the most common non albicans species causing fungemia. The objective of our study was to identify the risk factors and outcomes of CG BSI in comparison to other candida species (COS) in our ICU.

Methods:

We reviewed the demographic data, risk factors, treatment, and outcomes associated with Candida BSI at our institution (community teaching hospital) during a 3-year period from 2007-2009. Descriptive analysis was performed.

Results:

Of 28 patients with Candida BSI, 11 had CG and 19 had COS. 2 patients had both CG & COS and were included in both groups. The two groups were equally distributed for age and ethnicity.  The pertinent results are summarized in Table-1.

Results

C. Glabrata (CG) (n=11)

Candida Other species (COS) (n=19)

Prior Fluconazole exposure

(p = 0.013)

5

0

Mean ICU LOS

30+/-33

22+/-18

Mean Ventilator days

25+/-32

16+/-17

Mean APACHE II score

21+/-9

21+/-6

Candida colonization

(urine & sputum)

8 (72%)

11 (57%)

30 –day Mortality

7 (63%)

11 (57%)

Invasive procedures preceded candida colonization in 60% patients (75% CG, 54% COS). Of the 11 CG isolates, 6 were fluconazole susceptible (MIC < 8), 3 were susceptible but dose dependant (MIC 16-32) and 2 isolates had unrecorded MIC.

Conclusion:

CG was responsible for 39% of all candidemias at our institution. Prior fluconazole use was an independent risk factor for CG BSI consistent with previous observations in larger studies. Fluconazole use is common due to endemic coccidioidimycosis in our location. Higher incidence of CG infection may be anticipated. A trend towards increased mortality was observed in the CG group. We also hypothesize that Candida colonization is an important risk factor for development of CG BSI and invasive candidiasis in general.  

 


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

Speakers:
Aarthi Narasimhan, MD , Infectious Diseases, Community Regional Medical Center/ UCSF-Fresno, Fresno, CA
Nishchal Kumar, MD , Pulmonary and Critical Care Medicine, University of California at San Francisco, Fresno, Fresno, CA
Ali Rashidian, MD , Internal Medicine, University of California at San Francisco, Fresno, Fresno, CA
Narinder Gill, MD , Pulmonary and Critical Care Medicine, University of California at San Francisco, Fresno, Fresno, CA
Naiel Nassar, MD , Infectious Diseases, University of California, San Francisco, Fresno, School of Medicine, Fresno, CA
Vijay P. Balasubramanian, MD , Pulmonary and Critical Care Medicine, University of California at San Francisco, Fresno, Fresno, CA

Disclosures:

A. Narasimhan, None

N. Kumar, None

A. Rashidian, None

N. Gill, None

N. Nassar, None

V. P. Balasubramanian, None

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