1775. Impact of Infectious Diseases Consultation on Mortality in Patients with Candidemia
Session: Oral Abstract Session: The Fungus Among-us - Clinical Advances
Saturday, October 7, 2017: 8:43 AM
Room: 01AB

Background:

An infectious diseases (ID) consultation is often, but not always, obtained to help guide treatment of patients with candidemia. We examined if ID consultation affected patient outcome in patients with culture positive candidemia.

Methods:

We assembled a retrospective cohort of 1,873 cases of candidemia in patients hospitalized in our academic tertiary care hospital from 2002 to 2015. We collected data on comorbidities, predisposing factors; antifungal therapy, survival and ID consult. Patients who died within 24 hours of diagnosis were excluded, under the presumption that they did not have an opportunity to receive an ID consult. Survival analysis was performed via univariate and multivariate Cox Regression with censoring at 90 days, as subsequent mortality was less likely to be related to candidemia.

Results:

913 (49%) of the candidemic patients received an ID consult; 960 (51%) did not. Underlying comorbidities were evenly distributed between patients with and without an ID consult, except that patients with an ID consult more frequently had a central line (39% vs 26%, p<0.001), were on mechanical ventilation (4% vs 2%, p0.003) or were receiving extracorporeal membrane oxygenation (2.2% vs 0.5%, p 0.002). The ID consult group had lower 90-day mortality compared to patients without an ID consult (34% vs 49%, p<0.001), with an adjusted hazard ratio of mortality for those patients receiving an ID consult of 0.55 (95% CI: 0.48, 0.64, p<0.001) (Fig 1). Patient management differed significantly: the ID consult group was more likely to receive an echinocandin (29% vs 21%, p<0.001) or amphotericin B (AmB) (3.4% vs 1.4%, p=0.006).

Conclusion:

Candidemic patients who received an ID consult were significantly less likely to die, and were more likely to receive therapy with amphotericin or an echinocandin. These data suggest that an ID consult should be an integral part of clinical care of patients with candidemia.

Figure 1. Survival curve of 1873 patients with candidemia by receipt of ID consult adjusted for age above 50, receipt of chemotherapy, presence of central line, previous use of corticosteroids, receipt of ECMO and recent pleural procedure.

Carlos Mejia, MD, Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, Ryan Kronen, B.A., Washington University School of Medicine in St. Louis, St. Louis, MO, Charlotte Lin, MD, Internal Medicine, Washington University in St.Louis, St. Louis, MO, Kevin Hsueh, MD, Infectious Disease, Washington University in St louis, St Louis, MO, William G. Powderly, MD, FIDSA, Division of Infectious Disease, Washington University in St. Louis, St. Louis, MO and Andrej Spec, MD, Infectious Disease, Washington University, St Louis, MO

Disclosures:

C. Mejia, None

R. Kronen, None

C. Lin, None

K. Hsueh, None

W. G. Powderly, Merck: Grant Investigator and Scientific Advisor , Consulting fee and Research grant
Gilead: Scientific Advisor , Consulting fee
Astellas: Grant Investigator , Research grant

A. Spec, Astellas Pharma US, Inc.: Grant Investigator , Research grant

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