1642. Risk Factors for Micafungin non-susceptible Candida isolates
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Treatment
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Mica nonS RF ID Week Poster 10.16.2016_Final.pdf (962.2 kB)
  • Background: Echinocandins (EC) are the agents of choice for candidiasis in patients with risk factors for fluconazole resistant Candida.  With the emergence of EC non-susceptibility, identifying patients at risk is of utility to ensure optimal selection of empiric antifungal therapy.

    Methods: Adult inpatients with a Candida isolate in any culture were included.  Micafungin susceptibility was based on current CLSI standards.  Isolates with micafungin (Mica) intermediate sensitivity or resistance between 5/1/2012 – 4/30/2016 were included in the Mica non-susceptible group (MicaNS), while isolates that were susceptible to Mica between 5/1/2015-4/30/2016 were included in the Mica susceptible group (MicaS).  Patients in the MicaS group were randomized for inclusion in the risk factor analysis for comparison.  We also evaluated length of stay (LOS), and 30 day all-cause mortality.

    Results: 12 patients had MicaNS Candida, while 238 patients had MicaS Candida (20 patients were randomized for the risk factor analysis).  Baseline characteristics and the univariate analysis are shown in table 1.  On multivariate analysis, previous hospitalization within 90 days (p=0.02) and ICU admission (p=0.04) were independently associated with MicaNS.  All-cause 30-day mortality (33% vs 10%, p= 0.17) and LOS (48.2d vs 18.8d, p= 0.04) were higher in the MicaNS group. 

     

    TABLE 1

    MicaNS (n=12)

    MicaS (n=20)

     P-value

    Age (Mean)

    52.4

    61.6

    0.07

    Gender, Male (%)

    6 (50)

    14 (70)

    0.26

    Previous Hospitalization 90d (%)

    10 (83)

    8 (40)

    0.03

    DM (%)

    4 (33)

    3 (15)

    0.38

    ESRD (%)

    5 (42)

    2 (10)

    0.07

    Solid organ transplant (%)

    2 (17)

    0 (0)

    0.13

    Oncology diagnosis (%)

    2 (17)

    11 (55)

    0.06

    ICU (%)

    8 (67)

    6 (30)

    0.07

    TPN 14d (%)

    2 (17)

    1 (5)

    0.54

    Previous abdominal surgery 90d (%)

    3 (25)

    2 (10)

    0.34

    Previous Candida infection (%)

    5 (42)

    7 (35)

    0.72

    Previous EC exposure (%)

    6 (50)

    3 (15)

    0.05

    Days admitted prior to culture (days, mean) (%)

    22

    12.6

    0.32

    Conclusion:  ICU admission and prior hospitalization were found to be independent predictors for MicaNS Candida.  SOT, ESRD, and days admitted prior to culture may also contribute to the risk.  Patients with MicaNS Candida exhibited worse clinical outcomes with increased mortality and prolonged LOS.  Further studies are needed to fully elucidate clinical characteristics associated with MicaNS.

    Natasha Pettit, PharmD1, Zhe Han, PharmD1, Jennifer Pisano, MD2 and Angella Charnot-Katsikas, MD3, (1)Pharmacy Services, The University of Chicago Medicine, Chicago, IL, (2)Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL, (3)Department of Pathology, The University of Chicago Medicine, Chicago, IL

    Disclosures:

    N. Pettit, None

    Z. Han, None

    J. Pisano, Astellas: Scientific Advisor , Consulting fee and This occured in 2014, for isavuconazole

    A. Charnot-Katsikas, None

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