960. Epidemiology and risk factors of candidemia in a community hospital: retrospective analysis of 111 episodes
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Non-albicans species of Candida (NAC) are increasing in prevalence, compared to C. albicans.  While most candidemia studies are focused in severely immunocompromised hosts, little is known about the incidence of Candida bloodstream infection in the community hospital setting.   

Methods: A retrospective study was conducted to evaluate the epidemiology of candidemia in a community hospital and to determine the incidence and clinical prevalence of different Candida sp. Patients admitted to the Oakwood Healthcare System with ≥1 blood culture yielding Candida sp from Jan-2009 to Sep-2010 were included. Statistical analysis: Chi square test and t-test (p< 0.05) were used. 

Results: 111 episodes of candidemia (non-albicans Candida sp (NAC) and C. albicans were 61% and 39%, respectively) were identified in 103 patients.  NAC sp included C. glabrata (59%), C. tropicalis (26%), C. parapsilosis (12%), and C. guilliermondii (3%). Preliminary analysis of a subset of 75 pts was performed. Central venous catheter and use of steroids were associated with C. albicans candidemia (p 0.002 and 0.04) while female gender and use of Foley catheter were associated with C. glabrata candidemia (p 0.006 and 0.03, respectively). Other underlying conditions including cancer or hematologic malignancy, recent abdominal surgery, total parenteral nutrition, diabetes, etc, were comparable among both groups.  90 % of pts were treated with antifungal therapy, 75% of whom received fluconazole as first-line agent. Overall mortality was 35%.

Conclusion: Our study shows that NAC sp account for the vast majority of candidemia episodes in a community hospital setting. Among NAC, C. glabrata was the most frequent species isolated. No episodes of C. krusei were identified. Management of candidemia is difficult given the low sensitivity of blood cultures and the limitations of anti-fungal therapy. Antifungal toxicity and resistance, particularly among NAC isolates represent a major challenge for empirical therapeutic and prophylactic strategies. Understanding of the local epidemiology of candidemia and antifungal resistance patterns is critical may help to guide selection of empiric treatment, and ultimately decrease morbidity and mortality attributable to candidemia.


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

Marisa Miceli, MD and Vijayalakshmi Nagappan, MD, Medical Education -Internal Medicine, Oakwood Hospital and Medical Center, Dearborn, MI

Disclosures:

M. Miceli, None

V. Nagappan, None

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