250. Central Line-Related Candida glabrata Fungemia: Diagnostic Performance of Time-To-Reporting of Positive Blood Cultures
Session: Poster Abstract Session: Diagnostics: Mycology
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • ttr.pdf (979.4 kB)
  • Background: Central venous catheter (CVC) removal is beneficial in patients with CVC-related candidemia, defined as a higher colony count in a catheter lumen, compared to peripheral blood. However, clinicians are often faced with a blood culture growing Candida in a patient with a CVC, and few laboratories perform quantitative cultures. Therefore, it was proposed that short time-to-culture positivity (TTP) can be suggestive of catheter-related candidemia, in series of predominantly C. albicans candidemia episodes. Given the epidemiologic shift to non-albicans Candida species, and the longer time to detection for C. glabrata, compared to other Candida species, we studied the clinical characteristics of patients with CVC-related C. glabrata fungemia and the diagnostic utility of time-to-reporting (TTR) of positive blood cultures.

    Methods: We included patients with at least one blood culture(s) positive for C. glabrata, a CVC and available TTR, seen at M.D. Anderson Cancer Center between 3/2005-9/2013. CVC-related candidemia was defined as a colony count in a blood culture obtained via the CVC at least fivefold greater than the colony count in peripheral blood.

    Results: Fifty-six of 119 patients studied (49%) were deemed to have CVC-related candidemia. Those patients were less likely to be on total parenteral nutrition (TPN, 34[42%] vs. 48[59%] of those with non-CVC-related candidemia, P=0.01), or have an absolute neutrophil count <100/μL (2[4%] vs. 13[22%], P<0.01). TTR was shorter in patients with CVC-related candidemia (mean standard deviation, 6735 hours) compared to those with non-CVC-related candidemia (7931 hours, P<0.01), and had significant diagnostic value by ROC analysis (Figure). A TTR <48 hours was 99% specific for CVC-related candidemia.

    Conclusion: Among patients with C. glabrata fungemia, an abdominal source was more likely than CVC-related candidemia in severely neutropenic patients and in those receiving TPN. In the evaluation of patients with C. glabrata fungemia, a TTR of <48 hours could further support the decision to remove the CVC.

    Dimitrios Farmakiotis, MD, Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Jeffrey J. Tarrand, MD, Department of Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX and Dimitrios P. Kontoyiannis, MD, ScD, FIDSA, Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX

    Disclosures:

    D. Farmakiotis, None

    J. J. Tarrand, None

    D. P. Kontoyiannis, None

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