1591. The Importance of Scoring Systems in Patients with Candidemia
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Posters
  • idweek2016 candidemi.pdf (247.7 kB)
  • Background:For reasons such as the increasing need for both broad spectrum antibiotic use and total parenteral nutrition and the prolongation of life spans of patients with malignancies, candidemias are becoming a growing problem. The fact that, despite all technological advances, Candida spp. are seen in 50% of blood cultures shows that the problem is more serious than expected. The purpose of our study was to evaluate patients with candidemia and determine the importance of scoring systems.

    Methods:Patients with Candid spp. growth in blood cultures at our hospital between 2009-2014 were investigated retrospectively. Patients’ demographic and clinical characteristics, laboratory results, time to start of appropriate treatment, Charlson comorbidity index (CCI), SOFA and Pitt scores and prognoses were recorded from medical files. The data obtained were analyzed on SPSS 13.0.

    Results:115 patients were enrolled. Mean CCI score was 4.2±2.2, mean SOFA score was 7.4±4.1 and mean Pitt score was 4.8±3.2. Agents were C.albicans in 41.7%, C.guillermondi in 20%, C.parapsilosis in 17.4% and other non-Candida spp. in 20.9%. The crude mortality rate in the patients enrolled in the study was 65.2%. CCI, SOFA and Pitt scores were significantly high in the non-surviving patients (Table 1). Ten of the non-surviving patients were not started on antifungal therapy, 32 patients were started on appropriate antifungal therapy after 3 days and 8 of the surviving patients were started on appropriate antifungal therapy after 3 days (p=0.026). Multivariate analysis of the risk factors affecting mortality showed that a 1-unit increase in a patient’s CCI, SOFA and Pitt scores increased mortality 1.6, 1.3 and 2.0 fold, respectively, and that failure to start appropriate antifungal therapy in the first 3 days increased mortality 4.6-fold (Table 2). A CCI score above 4, a SOFA score above 7 and a Pitt score above 3 predict mortality in patients with Candidemia with high specificity and sensitivity (Table 3).

    Conclusion: Growth generally occurs after 3 days, leading to delays in treatment and increased mortality rates. Greater care is therefore required in the evaluation of at-risk patients in particular. At such evaluation, the use of CCI, SOFA and Pitt scoring systems in patients with risk factors and prompt initiation of antifungal therapy in patients with scores above cut-off values can be life-saving.

    Baris Ertunc, MD1, Gürdal Yilmaz, associated professor2 and Iftihar Koksal, proffessor2, (1)Clinic of Infectious Diseases and Clinical Microbiology, Alasehir Public Hospital, Manisa, Turkey, (2)Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey

    Disclosures:

    B. Ertunc, None

    G. Yilmaz, None

    I. Koksal, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.