215. Fungal Empyema Thoracis in Cancer Patients
Session: Poster Abstract Session: Candida Infection
Thursday, October 8, 2015
Room: Poster Hall
Background: Fungal empyema thoracis (FET) is a rare life-threatening infection for which the data are scarce. We sought to describe FET in a series of cancer patients and to differentiate true fungal isolates from contaminants in pleural fluid.

Methods: We conducted a retrospective chart review of patients who had a fungal isolate in a pleural fluid culture between 1/2005 and 8/2013. Based on EORTC/MSG diagnostic definition, FET was classified as a proven fungal disease (PFD), probable fungal disease or indeterminate, and risks for fungal infection were grouped as high risk (HR) and intermediate-low risk (IR).

Results: A total of 106 fungal isolates were identified in 97 patients. Candida spp. (58%) (mainly C. albicans and C. glabrata) and Aspergillus spp. (10%) were the most frequent pathogens. Compared to Aspergillus, Candida FET was associated with IR (81% vs. 36%, P=0.01), and preceding invasive thorasic or abdominal procedures (44% vs. 0%, P=0.01). In addition, patients with FET due to Candida spp. had frequent surgical drainage for empyema (65% vs. 27%, P=0.04) and better outcome (37% vs. 60%, P=0.32). All 11 pts with Aspergillus FET, and 83% of pts with Candida FET (45/54) were classified as a PFD. Three of Aspergillus group and 29% of Candida group (13/45), however, did not receive systemic antifungals (SA), but only one patient in each group (excluded one and three patients who lost follow up, respectively) had a poor outcome at six week (1/2, 50% and 1/10, 10%, respectively). Interestingly, eight out of the nine Candida untreated patients who had a favorable outcome without SA had IR. In non-Aspergillus molds, Penicillium spp. (N=12) were mainly isolated, however, excluded from this analysis since it is often considered as a laboratory contamination. Despite eleven patients with saprophytic molds were classified as a PFD, only one of them had persistent positive cultures. Most of the rest (8/10) were classified as IR, and did well without SA, except for one whose death was attributed to an underlying cancer.

Conclusion: While Candida FET was more frequent and associated with preceding procedures and IR, Aspergillus FET had a higher mortality. Most saprophytic molds appeared to represent non-pathologic isolates in pleural fluid, especially in IR patients.

Masayuki Nigo, MD, Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, Jose Munita, MD, Clinica Alemana - Universidad Del Desarrollo School of Medicine, Santiago, Chile; University of Texas Medical School at Houston, Houston, TX, Macarena Vial, MD, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, Ying Jiang, MS, 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, Carlos Jimenez, MD, The University of Texas MD 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:

M. Nigo, None

J. Munita, None

M. Vial, None

Y. Jiang, None

J. J. Tarrand, None

C. Jimenez, None

D. P. Kontoyiannis, Merck: Scientific Advisor , Research support
Pfizer: Research support , Research support
Gilead: Speaker's Bureau , Speaker honorarium
Astellas: Consultant and Speaker's Bureau , Speaker honorarium
F2G: Consultant , Consulting fee
T2 Biosystems: Speaker's Bureau , Speaker honorarium
Mylan, Inc: Speaker's Bureau , Speaker honorarium

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