212. Epidemiology and Outcome of Non-albicans Candida Bloodstream Infections (NAC-BSI) in a network of tertiary care hospitals in Mexico City: A 6-year laboratory based surveillance
Session: Poster Abstract Session: Candida Infection
Thursday, October 8, 2015
Room: Poster Hall
Posters
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  • Background: Candida spp is the 4th cause of nosocomial bloodstream infections (BSI). The incidence is higher in Latin America (LA) than in North America. NAC have emerged and increased, lately several risk factors have been described and C. parapsilosis and C. tropicalis have been reported as the most common species in LA. 

    Methods: Patients admitted to two referral hospitals, from July 2008 to June 2014 with a positive blood culture for Candida spp. were included and followed prospectively. The incidence rate of CBSI was calculated. Descriptive and comparative analysis by NAC and 30-day mortality was done. Multivariate analysis was performed: logistic regression for NAC associated factors, and a proportional hazard model for mortality. A p value < 0.05 was considered statistically significant. For the mortality analysis, only episodes with >48hrs of treatment and sufficient data to assess proper treatment (defined as adequate antifungal for the isolated species and appropriate doses) were included.

    Results: There were 227 episodes of CBSI among 225 patients. CBSI represented 1.7% of all BSI, the incidence rate was 3 episodes/1000 admissions (3.1/1000 admissions during the first year and 4/1000 admissions during the last year, p=0.5). One hundred and thirty four isolates (59%) were identified as NAC: 37% C. tropicalis, 33% C. glabrata, 15% C. parapsilosis, 4.4% C. guilliermondi. NAC-BSI had a trend to increase from 1.73 to 2.4/1000 admissions (p=0.0.4). Chronic kidney disease (CKD) (OR 5.9 95% CI 1.9-18), previous antifungal therapy (OR 2.7 95% CI 1.3-5.9), and chemotherapy (CT) (OR 2.0 95% CI 1.09-4.0) were independently associated with NAC-BSI. After adjustment with proper treatment and age, early (<72 hr) central venous catheter removal (HR 0.68 95% CI 0.49-0.96), disease severity (APACHE II) (HR 1.06 95% CI 1.03-1.10) and cirrhosis (HR 3.4 95% CI 2.21-5.27) were independently associated to 30-day mortality in NAC-BSI. 

    Conclusion: NAC-BSI showed a trend to increase the isolation rate in this setting, being C. tropicalis the most prevalent species; CKD, previous antifungals, and CT were major risk factors. Cirrhosis and disease severity were associated with increased 30-day mortality, while early catheter removal seemed to reduce the risk.

    Maria F. González-Lara, MD1, Pedro Torres-González, MD2, Alfredo Ponce De Leon-Garduño, MD2, Patricia Cornejo-Juarez, MD, MSc3, Dora E. Corzo-Leon, MD4 and José Sifuentes-Osornio, MD, FIDSA5, (1)Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico, (2)Clinical Microbiology Laboratory, Natl. Inst. of Medical Sci. and Nutrition Salvador Zubirán, Mexico City, Mexico, (3)Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico, (4)Infectious Diseases/Microbiology Laboratory, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City, Mexico, (5)Clinical Microbiology Laboratory, Instituto, Mexico City, Mexico

    Disclosures:

    M. F. González-Lara, None

    P. Torres-González, None

    A. Ponce De Leon-Garduño, Pfizer: Board Member and Scientific Advisor , Grant recipient
    MSD: Board Member , Grant recipient
    Jannsen-Cilag: Scientific Advisor , Speaker honorarium

    P. Cornejo-Juarez, Astra-Zeneca: Scientific Advisor , Speaker honorarium
    MSD: Investigator , Research grant
    Merck: Speaker's Bureau , Speaker honorarium
    Stendhal: Speaker's Bureau , Speaker honorarium

    D. E. Corzo-Leon, Pfizer: Collaborator , Salary

    J. Sifuentes-Osornio, None

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