961. 211 Cases of Candida Osteomyelitis: 17 Case Reports and a Review of the Literature
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Candida Osteo IDSA poster.pdf (542.9 kB)
  • Background:  Candida osteomyelitis is a rare infection with substantial morbidity and mortality. 17 cases of Candida osteomyelitis from our institution and 194 from the literature were reviewed. 

    Methods:  Patients treated in our institution (2000-2010) and the literature (1928-2010) were included if they had biopsy proven or imaging suggestive of osteomyelitis, and isolation of Candida from cultured bone.  Univariate analyses were peformed using Fisher's test.

    Results:  76% (132/196) of patients were male.  Mean age was 54 ± 17.7 years (range: 18-90 years).   Risk factors included surgery (109, 57%), antibiotics (81, 42%), prior Candida colonization or infection (75, 39%), and central venous catheter usage (40, 21%).  45% (61/135) of patients had evidence of candidemia prior to infection.  The most common sites of infection were vertebral (130/211, 62%) and sternum or chest wall (51/211, 24%). Identified species were C. albicans (142/203, 70%), C. tropicalis (31/203, 15%), C. glabrata (17/203, 8%), and C. parapsilosis (9/203, 4%).  C. albicans versus non-albicans osteomyelitis was related to clinical cure (123/132 vs. 42/51, p=0.049).  The most common treatment regimens were amphotericin B (76/190, 40%) and fluconazole (51/190, 27%).  Echinocandins were infrequently used (7/190, 4%).  Combination therapy was used (33/190, 17%), most commonly with amphotercin B and flucytosine (29/33, 88%).  Mean length of therapy was 4.7 ± 4.7 months (median: 3 months; range: 18 days to 36 months).  Therapy was reported to be successful in 84% (159/189).  Mean length of therapy in successfully treated patients was 4.3 ± 4.0 months (median: 3 months, range: 18 days to 24 months).  82% (130/159) of patients were treated for 6 months or less, with the majority (114/130, 88%) treated successfully. Attributable mortality was 5% (10/189).  Crude mortality was 12% (23/189). 

    Conclusion:  C. albicans was the most common species in this series and was associated with improved rates of clinical cure compared to non-albicans species.  Length of treatment was variable; however, the majority of patients were treated successfully with 6 months or less of therapy.  Attributable and crude mortality rates were lower than those reported in the literature for other types of invasive candidiasis. 


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

    Amy Slenker, MD, Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, PA, Scott Keith, Ph.D., Division of Biostatistics, Thomas Jefferson University Hospital, Philadelphia, PA and David Horn, MD, Thomas Jefferson University Hospital, Philadelphia, PA

    Disclosures:

    A. Slenker, None

    S. Keith, None

    D. Horn, Astellas: Consultant, Consulting fee

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