IC encompasses candidemia and deep-seated infections that do not stem from hematogenous dissemination of Candida. The full spectrum of IC at individual hospitals is poorly understood. Our goal was to describe the epidemiology and clinical spectrum of IC at two large university medical centers.
We conducted a retrospective review of + Candida cultures from sterile sites in 2014. Cultures of urine and drains in place for > 24 hrs were excluded, as were cases of Candida colonization.
Centers comprise urban, tertiary care, level 1 trauma hospitals with >600 acute-care beds, which operate large critical care and kidney-pancreas transplant programs. Center A houses pediatric, obstetrics-gynecology and oncology programs that are not present at center B. Center B is a leading center for liver, intestinal and cardiothoracic transplant, which are not performed at center A, and home to a large high-risk GI surgery program. 54 and 277 cases of IC were identified at center A and B, respectively. Across the centers, the most common manifestations of IC were intra-abdominal (IAC, 45%), candidemia (34%), osteomyelitis/septic arthritis (10%), pleural/mediastinal (5%) and others (6%; e.g., CNS, meningitis, aortitis, vascular grafts). At center A, candidemia and IAC represented 45% and 40% of IC, respectively. At center B, candidemia and IAC represented 31% and 46% of IC, respectively. C. albicans and C. glabrata were responsible for 36% and 34% of candidemia, respectively. For IAC and other types of IC, corresponding figures were 76% and 11%. Bacterial co-infections were diagnosed in 30% of candidemia, and 67% of IAC; 7% of IAC cases had concomitant candidemia. Antifungal agents were administered in >98% and 74% of candidemia and IAC, respectively. Mortality rates (100 d) were 48% and 27%, respectively.
At both hospitals, non-candidemic IC was more common than candidemia. There were numerous differences between candidemia and other types of IC, including the performance of blood cultures, distribution of Candida spp., predominance of polymicrobial infections, likelihood of antifungal treatment, and patient outcomes. More studies of non-candidemic IC are clearly needed, since well-described epidemiologic, antifungal pharmacokinetic/dynamic and outcome data from candidemia trials cannot be extrapolated to other types of IC.
P. Vergidis, None
G. R. Thompson, Astellas: Consultant , Consulting fee and Grant recipient
M. H. Nguyen, None
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