1600. Retrospective Review of Candidemia at a Tertiary Care Hospital in New Orleans
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Background: Candidemia remains a serious medical problem with high morbidity and mortality despite current available antifungal treatments. In recent years, non-albicans Candida spp have increased in prevalence and in rates of antifungal resistance. A retrospective review of all candidemia cases was performed from Jan 2009 to Dec 2015 at Ochsner Medical Center, New Orleans, LA.

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.

Lydia Breskin, MS1, Julia Garcia-Diaz, MD, FIDSA2, Laya Reddy, BS3, Alessandro Iliceto, B.A.4, Deborah Ashcraft, B.S.5, Allison Egger, MPH6 and George Pankey, MD, FIDSA5, (1)Tulane University School of Medicine, New Orleans, LA, (2)Infectious Diseases, Ochsner Clinic Foundation, New Orleans, LA, (3)University of Queensland/Ochsner Clinical School, Jefferson, LA, (4)University of Queensland/ Ochsner Clinical School, Jefferson, LA, (5)Institute of Translational Research; Laboratory of Infectious Disease Research, Ochsner Clinic Foundation, New Orleans, LA, (6)Infectious Disease, Sinai Hospital of Baltimore, Baltimore, MD

Disclosures:

L. Breskin, None

J. Garcia-Diaz, Astellas Pharma US: Consultant , Investigator and Scientific Advisor , Consulting fee

L. Reddy, None

A. Iliceto, None

D. Ashcraft, None

A. Egger, None

G. Pankey, None

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