955. Candida Osteomyelitis: Epidemiology, Management and Outcomes of 122 Reported Cases
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Candida osteomyelitis is a debilitating form of deeply invasive candidiasis.  However, its epidemiology, clinical manifestations, management and outcome are not well understood.  We therefore undertook a comprehensive analysis of published cases of Candida osteomyelitis.

Methods: We identified 122 evaluable cases of Candida osteomyelitis reported in available literature from 1971 through 2011. Among the variables studied were presence of Candida spp. in bone, primary underlying condition, pharmacological immunosuppresion, clinical manifestations, therapy (antifungal therapy (AFT), AFT and surgery, and surgery), breakthrough infections and outcome.

Results: Among 122 evaluable patients (pts), there were 85 males (70%). Median age was 59 y (range <1-80 y).  Among 14 pediatric pts, there were 9 neonates. Pts in this study exhibited an overall 13% mortality (16/122).   During the past 4 decades, there was an approximately 4-fold increase of Candida osteomyelitis.  Among patients with possible predisposing conditions, 75% were not pharmacologically immunosuppressed, 15% were neutropenic, and 10% treated with glucocorticosteroids.  Localizing symptoms and signs of fever, pain, tenderness and/or edema were present in 116 (95%) of pts.  The most common sites of infection were vertebral bodies (61%), extremity long bones (21%), and ribs (14%). Among the Candida spp., C. albicans constituted 58%, C. tropicalis16%, C. glabrata 7%, C. parapsilosis 4%, and more than one species 4%.  Among the patterns of infection, 49 (40%) emerged during antifungal therapy and 73 (60%) were considered to be de novo.  Overall response (CR and PR) to AFT alone (n=44) was 82%, while that for AFT plus surgery (n=66), which was in more complicated cases, was 58%.

Conclusion: Candida osteomyelitis is being reported with increasing frequency, especially in non-pharmacologically suppressed pediatric and adult patients.  Localizing symptoms are usually present and the vertebral bodies are the most common sites. C. albicans and C. tropicalis are the most frequently isolated organisms. Emergence of Candida osteomyelitis commonly occurs during AFT.  Management of Candida osteomyelitis remains challenging and its outcome tenuous, despite AFT and surgery.


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

Maria Gamaletsou, Weill Cornell Medical College of Cornell University, University of Athens, Greece, New York, NY, Dimitrios Kontoyiannis, MD, ScD, FACP, FIDSA, MD Anderson Cancer Center, Houston, TX, Houston, TX, Barry Brause, Weill Cornell Medical College of Cornell University and Hospital for Special Surgery, New York, NY and Thomas Walsh, MD, FIDSA, Weill Cornell Medical College of Cornell University and NewYork-Presbyterian Hospital, New York, NY

Disclosures:

M. Gamaletsou, None

D. Kontoyiannis, None

B. Brause, None

T. Walsh, None

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