628. The Changing Face of Candidemia in the Non-Neonatal Population
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Candida species are the 4th most common cause of health care-associated bloodstream infection (BSI). Although C. albicans (CA) remains the predominant species, there has been an increasing trend towards Candida non-albicans infections (NAC). Few studies have investigated candidemia among pediatric patients outside of the neonatal age group. Furthermore, little data exist regarding the impact of NAC BSI in this population. We hypothesize that NAC BSI has increased over the past 10 years at Texas Children’s Hospital (TCH) and that there may be differences in risk factors and outcome between patients with CA vs. NAC BSI.

Methods: A retrospective review was performed of children aged 6 mos-18 yrs admitted to TCH from 1/99 - 12/08 with blood culture proven candidemia. Clinical and demographic data were collected and compared between patients with CA vs. NAC BSI.

Results: 263 episodes of candidemia occurred in 214 patients. The median patient age was 50 mos (range 6 mos – 18 yrs) with 52.7% males; 41 % were Hispanic and 30% White. CA was the most common (42%) species causing BSI although, collectively, NAC was more frequently isolated (58%). Among the NAC group, C. parapsilosis was most common (24%) followed by C. tropicalis (15.7%), C. glabrata (7%) and C. lusitaniae (5%). No difference was found between the two groups in terms of demographics, underlying diagnosis, antibiotic use, ICU related care, parenteral nutrition, neutropenia, catheter use, receipt of prior antifungal therapy or 30-day mortality. Neutropenia (OR 4.6; p=0.01), use of vasopressors (OR 5; p=0.05) and prolonged fungemia (> 3 blood cultures) (OR 3.4; p=0.03) were independently associated with disseminated disease (DC). NAC fungemia showed a trend towards being associated with DC but was not statistically significant (OR 2.5; p=0.1)

Conclusion: Though CA was the single most common species responsible for Candida BSI at TCH, NAC species collectively have emerged as the predominant etiology of candidemia in non-neonatal patients. Although mortality and risk factors were the same between the two groups; the risk of DC was increased with neutropenia, use of vasopressors and prolonged fungemia.


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

Speakers:
Ankhi Dutta, MD , Baylor College of Medicine, Houston, TX
Debra Palazzi, MD , Baylor College of Medicine, Houston, TX

Disclosures:

A. Dutta, Yes
Merck & Co., Inc.: Grant awardee for this study, Research grant

D. Palazzi, Yes
Merck & Co., Inc.: Grant Investigator,

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