966. The Gastrointestinal Tract (GIT) Is The Source Of Candidemia In Immunocompromised Patients With Hematologic Malignancies
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Central venous lines (CVL) have long been thought as the source of bloodstream infection (BSI) with Candida spp. (candidemia) and society guidelines recommend CVL removal as a therapeutic maneuver. However, Candida species is a normal constituent of the gut flora and may be the source of candidemia.  We evaluated the association of candidemia with GIT pathology. Methods: We conducted a retrospective review of the medical records of patients with hematologic malignancies and candidemia between June 2008 and September 2010. Patients included in the analysis had undergone ≥ 2 BDG, 2 ≥ blood cultures and abdominal computer tomography (CT) scans to evaluate GIT pathology including enteritis (E), enterocolitis (EC) and colitis(C). The following GIT-related variables were evaluated; clinical findings (oral mucositis and diarrhea), laboratory studies (stool positive C. difficile toxins), concomitant medications (anti-diarrheal agents, oral vancomycin, oral metronidazole) and CT scans. In addition, we examined the results of CVL tip cultures when available. Fisher Exact probability test was used to calculate p value. Results: Forty one episodes occurred in 26 patients; 26 episodes with candidemia and 14 control episodes in which patients whose candidemia had resolved (own controls). All patients with candidemia had GIT symptoms most commonly diarrhea (100%). Radiographically evident enteritis was present in 16 of 26 episodes of candidemia (62%) vs. 3 of 15 control episodes (20 %). p=0.02 (two-tailed). One of the 18 cultured CVL tips (5.5%) in 13 patients (8%) yielded Candida spp.This patient had radiographic evidence of septic thrombophlebitis and removal of the CVL failed to clear the BSI. Conclusion: This preliminary analysis highlights the increased incidence of GIT pathology in patients with candidemia. Also GIT is the primary source of candidemia in adult cancer patients receiving chemotherapy.

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

Zainab Shahid, M.D.1, Naveen Sanath kumar, M.D1, Jameel Muzaffar1, Monica Grazziutti, MD1, Sajjad Haider, M.D.1, Lakshmikanth Katragadda, M.D.1, Alejandro Restrepo, M.D.1, Marcio Nucci, MD2 and Elias Anaissie, MD1, (1)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR, (2)Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro - RJ , Brazil

Disclosures:

Z. Shahid, None

N. Sanath kumar, None

J. Muzaffar, None

M. Grazziutti, None

S. Haider, None

L. Katragadda, None

A. Restrepo, None

M. Nucci, Pfizer: Board Member, Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Educational grant, Research grant and Speaker honorarium
Merck: Board Member, Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant and Speaker honorarium
Astellas: Board Member, Consultant and Scientific Advisor, Consulting fee and Speaker honorarium

E. Anaissie, None

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