Methods: This study yielded 328 patients and results from 316 is presented here. Data was collected from the electronic medical record and analyzed in SAS (v. 9.4, SAS Institute, Cary, NC), using the Pearson’s Χ2 test. Antifungal susceptibility testing was performed by Vitek® 2 System.
Results: The most common species (n=316) were Candida glabrata [CG] (39.2%), Candida albicans [CA] (39.2%), and Candida parapsilosis [CP] (18.0%). No significant differences were found in patient gender (male=55.7%) or age; overall mean age was 55.5 +/- 18.7 yrs. Of patients with known sources, the most common source was line related (58.6%, 68/116). Patients in the ICU were more likely to have CG (44.7%, 68/152) or CA (45.4%, 69/152) than CP (9.9%.15/152). CG was more frequent in patients who had previously received antifungal prophylaxis (73.9%; 17/23, p=0.003), with the most common agent being fluconazole (87.0%, 20/23); there was no significant difference in patients receiving empiric therapy among species. Risk factors identified (n=316): lines (CVC: 64.6%); TPN (43.7%); dialysis (23.7%); ventilatory support (49.7%) and prior antimicrobial therapy (44.3%). Only 1.8% had WBC <1000 cells/mm3. During this time period, 144 CG isolates were available for fluconazole susceptibility testing; 126 (87.5%) were susceptible-dose dependent and 18 (12.5%) were resistant. All-cause mortality was 62.4% (289/303) and attributable mortality was 13% (37/284). Although the guidelines recommend an eye exam on all patients with candidemia, only 20.3% of patients had eye exams (62/305); 9.8% (10/62) of those had changes related to candidemia.
Conclusion: The species distribution has been changing over the past few years and continues to do so based on the pressure exhibited by our antifungal usage. Our morbidity and mortality remains high and we need to have a high index of suspicion to institute early treatment in these at-risk patients.
L. Reddy, None
A. Iliceto, None
D. Ashcraft, None
A. Egger, None
G. Pankey, None
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