896. Micafungin treatment and eradication of candiduria among hospitalized patients
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  In high risk patients, candiduria may be associated with the development of UTI and invasive candidiasis. The triazole antifungals achieve good urine concentrations but their use is limited by the emergence of non-albicans Candida species with low triazole-susceptibility.  The Echinocandins remain cidal against many azole-resistant Candida species but low urine levels have limited their use.   We examined the rates of candiduria elimination among patients who were treated with micafungin.

Methods:  A retrospective analysis in two tertiary-care centers in Boston of consecutive patients with candiduria who were treated with micafungin and had post-micafungin urine cultures from 1/2008 to 4/2011. Using standard definition, patients were labeled as having candiduria or UTI and were assessed for short-term (within 2w post micafungin) and long-term (>1 month from micafungin discontinuation) sterilization of urine. Data collected included demographics, microbiology, antibiotic exposure, comorbidities, presence and replacement of Foley catheters.

Results:   We identified 33 patients with candiduria who were subsequently treated with micafungin.  Of these, 16 (48%) had UTI, and 2 (6%) had Candida growing in clinical cultures from other sites.  A total of 25 patients (76%) had a Foley catheter, which was replaced in 11 of the 25 (44%). Candida species included C. albicans (13 patients, 39%) and C. krusei or C. glabrata (11, 33%). Eight patients (24%) were immunocompromised and 29 or 33 (88%) received broad-spectrum antibiotics.  Rates of urine sterilization during micafungin treatment, 2 weeks after micafungin, and >1 month after completion of micafungin therapy were 81%, 78%, and 75%, respectively. Rates of short-term Candida eradication among patients with Foley replacement vs. no replacement were 6/9 patients (67%) vs. 10/11 (91%) (p=0.18) and among those with C. albicans vs C. glabrata or C krusei were 11/12 (92%) vs. 7/9 (78%) (p=0.37).  

Conclusion: Among hospitalized patients with candiduria, micafungin administration was frequently associated with both short-term and long-term urine sterilization. This was observed among patients with or without Foley removal and among those with C. albicans as well as non-albicans Candida species.


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

Yoav Golan, MD MS1, Mihir Sura, MD1, Anisa Mohammed2, Spencer Martin, PharmD2 and Steven Gabardi, PharmD2, (1)Tufts Medical Center, Boston, MA, (2)Brigham and Women's Hospital, Boston, MA

Disclosures:

Y. Golan, Astellas: Grant Investigator, Grant recipient

M. Sura, None

A. Mohammed, None

S. Martin, None

S. Gabardi, Astellas: Grant Investigator, Grant recipient

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