954. The Changing Epidemiology of Healthcare-Associated Candidemia over Three Decades
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Candida are the most common fungal cause of healthcare-associated bloodstream infection.  We described the epidemiology of healthcare-associated candidemia (HAC) at the Univ of Iowa (UI) in both the pre-fluconazole (pre-FLU) and pre-echinocandin (pre-EC) eras.  We now reexamine the epidemiology of HAC in comparison with pre-FLU and pre-EC cohorts.

Methods: We identified all UI patients (pts) with HAC using microbiology records from 1/04-12/07, abstracted clinical data from medical records, and pulled isolates for susceptibility testing by CLSI broth dilution method.  We compared mortality, underlying illness, Candida species distribution, and antifungal susceptibility with two prior UI cohorts: 88 pts from pre-FLU (1983-1986; Wey, et al., Arch Intern Med 1988) and 108 pts from pre-EC (1997-2001; Gudlaugsson, et al., Clin Infect Dis 2003).

Results: Of 108 pts with HAC from 2004-2007, species distribution was 47% C. albicans (CA), 29% C. glabrata (CG), 12% C. parapsilosis (CP), 6% C. tropicalis, and no C. krusei.  Compared with pre-FLU and pre-EC eras, there was a reduction in % CA (from 61 and 60%, respectively), an increase in % CG (from 0 and 16%), and no change in % CP over time (12% and 12%). In-hospital mortality was lower in 04-07 than both pre-FLU and pre-EC (31% vs. 57-61%), and 30-day mortality was also lower (33%, vs. 48% in pre-EC). Mean Charlson index was lower for the 04-07 cohort than pre-EC (3.0 vs. 3.4)—fewer pts had leukemia or lymphoma (8% vs. 16%) or other malignancies (18% vs. 24%), while more were surgical patients (58% vs. 48%). Using the new (lower) CLSI breakpoints for FLU and our formulary EC (caspofungin), we found no EC resistance, and FLU resistance only among CG (15% of CG had FLU MICs >32 mcg/mL), unchanged from prior cohorts.

Conclusion: The epidemiology of HAC is changing at our tertiary care hospital, with reduction in CA disease and continued emergence of CG, fewer cases among oncology pts, and lower in-hospital and 30-day mortality .  Introduction of EC use has not resulted in an increase in CP as a cause of HAC, or in early emergence of EC resistance.  Future investigation is needed of decreased mortality rates, which may be due in part to improved preventive strategies among sicker patient populations (e.g. oncology).

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

Daniel J. Diekema, Sophie Arbefeville, MD, Linda Boyken, Jennifer Kroeger, MS and Michael A. Pfaller, M.D., University of Iowa Carver College of Medicine, Iowa City, IA


D. J. Diekema, Merck: Grant Investigator, Research grant

S. Arbefeville, None

L. Boyken, None

J. Kroeger, None

M. A. Pfaller, None

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