898. Treatment and Outcomes of Invasive Candidiasis at a Tertiary Care Center
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1

Background: Mortality rate from invasive candidiasis has historically been high. The objective of this was to characterize the use of antifungals in the treatment of patients with invasive candidiasis (IC) or candidemia (C) using only electronic data.


Methods: We performed a retrospective cohort study of patients with IC or C who were admitted to a 1250-bed tertiary care center from 10/1/2004 to 12/31/2009. Only electronic data was used for this study. Multivariate analyses were performed using Cox Proportional Hazards modelling (independent outcome was 28-day mortality) and Logistic regression modelling (independent outcome was microbiological failure or 28-day mortality). A P-value of <0.05 was considered statistically significant.


Results: 963 patients met our study definition. Mean age was 57 ± 16 years (17-96 years). 66% (634/963) had candidemia while 34% (328/963) had invasive candidiasis without candidemia. The 28-day mortality rate was 25% (244/963) and microbiological failure rate was 36% (343/963). Antifungal agents prescribed, defined as a single active agent for 10 days, were fluconazole (19%; 184/963), anidulafungin (9%; 86/963), caspofungin (5%; 44/963), voriconazole (<1%; 4/963), and amphotericin B (<1%; 2/963). The rest of the patients were treated with multiple agents, less than 10 consecutive days, or inappropriate agents. On both multivariate analyses, significant predictors of 28-day mortality or microbiological failure included admission to the ICU[aOR 1.7; 95% CI (1.3,2.2)], a higher modified Apache II score [2.4 (1.3,4.3)] , C vs. IC only [3.2 (2.4,4.2)], hepatic dysfunction [2.2 (1.4,3.4)], and malignancy [1.8 (1.3,2.5)]. Only treatment with anidulafungin for at least 10 consecutive days after the positive culture was associated with increased survival at 28 days or microbiological cure [0.4 (0.2. 0.6)].


Conclusion: Mortality among patients with invasive candidiasis was 25%. Predictors for mortality or microbiological failure included admission to the ICU, a longer length of stay, a higher modified Apache II score, candidemia vs. invasive candidiasis only, hepatic dysfunction, and presence of malignancy while treatment with anidulafungin was associated with increased survival or microbiological cure.




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

Emily J Kuo, MPH, Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, Laura A. Puzniak, PhD, MPH, Pfizer Inc, Collegeville, PA, Joshua A Doherty, BS, BJC Healthcare, St. Louis, MO, Richard M. Reichley, PharmD, Medical Informatics, BJC Healthcare, Saint Louis, MO and Bernard C. Camins, MD, MSCR, Department of Medicine, Washington University School of Medicine, St. Louis, MO


E. J. Kuo, None

L. A. Puzniak, Pfizer, Inc. : Employee, Salary

J. A. Doherty, None

R. M. Reichley, None

B. C. Camins, Pfizer, Inc. : Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research grant, Research support and Speaker honorarium

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