1594. The Clinical Value of Infectious Disease Consultation for Patients with Candidemia in a Tertiary Care Hospital in Japan over a 12-Year Period
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall

Background: Candidemia is an important cause of mortality in health-care settings, and its management requires broad range of diagnostic and therapeutic strategies. Infectious disease consultation (IDC) might improve its outcomes. However, the information available is limited and from a short period.

Methods: We conducted a retrospective cohort study of all candidemia patients at the National Centre for Global Health between January 2002 and December 2013. Medical records were reviewed, and clinical characteristics and outcomes were compared between the IDC and no-consultation groups.

Results: We identified 301 candidemia episodes. Of them, 127 (42.2%) were from IDC group. Candida albicans was most frequently detected (133 [44.2%]), followed by C. glabrata (78 [25.9%]), and C. parapsilosis (46 [15.3%]). Candida species did not differ between the 2 groups. The 30-day mortality was significantly lower in the IDC group (24 [19%] vs 58 [33%], OR: 0.47 [0.27–0.8], p=0.006), even after controlling for the confounding effects of the Charlson comorbidity index, age, sex, and immunosuppressive status by performing a multivariate analysis (adjusted OR: 0.48 [0.28–0.84], p=0.01). Severity of illness (severe sepsis/septic shock) did not differ between the 2 groups. Peripheral line-associated bloodstream infection (PLABSI; p=0.012), polymicrobial bacteremia (p=0.029), and source control (e.g., catheter removal and abscess drainage; p=0.049) were more common in the IDC group.

Conclusion: In candidemia patients, IDC was independently associated with reduced 30-day mortality. To improve the outcome of candidemia patients, IDC should be actively considered.

Table: Comparison of candidemia patients with and without ID Consultation

ID consultation

p value

Yes (n=127),

n (%)

No (n=174),

n (%)

30-day mortality

24 (19)

58 (33)

0.006

(adjusted p value: 0.01)

Endopthalmitis

18 (14)

15 (9)

0.139

Central line-associated bloodstream infection

93 (73)

140 (80)

0.163

PLABSI

23 (18)

14 (8)

0.012

Intra-abdominal infection

8 (6)

6 (3)

0.277

Unknown source

3 (2)

14 (8)

0.043

Antifungal therapy duration, median days (IQR)

19 (15–31)

14 (4–18)

<0.001

Source control

106 (84)

128 (74)

0.049

Polymicrobial bacteremia

18 (14)

11 (6)

0.029

Severe sepsis/septic shock

66 (52)

96 (56)

0.56

Masahiro Ishikane, M.D., Kayoko Hayakawa, M.D., Ph.D., Satoshi Kutsuna, M.D., Ph.D., Nozomi Takeshita, M.D., Ph.D. and Norio Ohmagari, M.D., M.Sc., Ph.D., Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan

Disclosures:

M. Ishikane, None

K. Hayakawa, None

S. Kutsuna, None

N. Takeshita, None

N. Ohmagari, None

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