968. Epidemiology and Outcome of Candida bloodstream Infection at a Tertiary Care Center in Cleveland-Ohio
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  Changing trends have been documented in species distribution and susceptibility of bloodstream infections (BSIs) caused by Candida species. We investigated the epidemiology and outcome of patients with candidemia caused by C. albicans and non-albicans species at a tertiary care center in Cleveland, Ohio.

Methods: We retrospectively reviewed a cohort of patients aged >18 years with Candida BSIs at University Hospitals Case Medical Center, from 2002 to 2009. Predisposing factors and outcomes were analyzed using SPSS software version 19 (SPSS, Chicago,IL).

Results: Three hundred and thirteen patients with Candida BSIs were identified (male/female: 140/173, Mean age (years): 60.8±16.6/60.29±16.52, respectively). C. albicans was the most frequently isolated species (45.4%), followed by C. glabrata (28.5%), C. parapsilosis (15%), C. tropicalis (8%), C. krusei (1.3%) and C. lusitaniae (0.3%). Overall, resistance to fluconazole was 13.1% mainly detected in C. glabrata (30.3% and 5% for C. glabrata and C. albicans isolates, respectively). Crude 30-day mortality was high in both albicans and non-albicans groups [42.3% (55/130) vs. 37.8% (56/148); OR for survival in the albicans compared the non-albicans group was 0.83; 95%CI (0.51-1.34, P=0.4)]. There was no difference in the mean days to death between both groups [7.58±8.07; 8.6±7.67, P=0.5 for albicans and non-albicans group, respectively]. Inappropriate antifungal therapy as defined by daily dose and in vitro susceptibility and fluconazole minimum inhibitory concentration were not shown to be  significant factors associated with 30 days mortality in univariate analysis (P=0.71 and P=0.61, respectively). We found that liver disease [OR: 3.06; 95%CI (1.27-7.38)], intensive care settings [OR: 5.42; 95%CI (2.51-11.70) and central venous catheter removal [OR: 0.22; 95%CI (0.09-0.50) to be independent predictors of 30 days mortality in multivariate analysis

Conclusion: C. glabrata fluconazole resistant has emerged as in important cause of candidemia. Our findings underscore the recent infectious disease society empiric treatment changes.  The lack of difference in mortality between albicans and non-albicans group suggests that host variables have the greatest impact on mortality.


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

Rana Traboulsi, MD, Case Western Reserve University/Center For Medical Mycology/University Hospitals Case Medical Center, Cleveland, OH, Elyse LeeVan, School of Medicine,Case Western Reserve University, , Cleveland, OH, Michael Jacobs, MD, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH, Mahmoud Ghannoum, PhD, Case Western Reserve University/Center For Medical Mycology, Cleveland, OH and Robert Salata, MD, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH

Disclosures:

R. Traboulsi, None

E. LeeVan, None

M. Jacobs, None

M. Ghannoum, None

R. Salata, None

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