188. Epidemiology, Risk factors and Outcomes of Candida Empyema: A 5-year Single Centered Experience
Session: Poster Abstract Session: Clinical Mycology
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Candida empyema J Williams ID week poster draft 2017 FINAL pdf.pdf (318.1 kB)
  • Background: Candida empyema is a rare manifestation of invasive candidiasis and can occur as a result of candidemia or direct inoculation of the pleural space after thoracic or abdominal surgeries. The risk factors and outcomes of candida empyema are poorly defined.

    Methods: We performed a retrospective descriptive analysis of all patients that had Candida species isolated from pleural fluid, from May 2012 to April 2017 at our institution.

    Results:

    Sixty patients with Candida empyema were identified. Patient characteristics are shown in Table 1. The majority of patients 68% had contiguous surgery and 25% had recent solid organ transplantation most of these were lung/heart transplants. The majority isolates were non– Candidia albicans species (52%). 52 patients (86.7%) received antifungals treatment for empyema: 72% received an azole and 13% received an echinoncandin. Fluconazole was the most frequent antifungal (63.3%). Mean duration of treatment was 4 weeks. Of these patients 78% underwent chest tube drainage (40% before diagnosis, 39% after diagnosis) and 22% required VATS/decortication. The overall 30-day mortality was 30%. Candidemia was noted in 7 patients (11.7%). 30-day mortality was associated with sepsis OR 1.04-11.4 – p=0.049, history of diabetes p=0.045 and sepsis at the time of candida isolation. A history of solid organ transplantation had a negative effect on mortality OR 0.01 -1.07

    Conclusion: Candida empyema was associated with recent contiguous surgery in the majority of cases including lung/heart transplants. Candida empyema is associated with significant mortality despite antifungal treatment and drainage as was associated with sepsis syndrome and diabetes.

    Variable

    N= 60

    Candida albicans 29 (48.3%)

    Non- Candida albicans 31 (51.7)

    P value

    Gender

    Male 40 (66.7)

    20(69)

    20(64.5)

    0.78

    Malignancy

    16 (26.7)

    7 (24.1)

    9 (29)

    0.77

    Procedure within 1 year

    41 (68.3

    20 (69)

    21(67.7)

    0.99

    Transplant

    15(25)

    6 (20.7)

    9 (29)

    0.56

    Sepsis at time of infection

    31(51.7)

    14(48.3)

    17(54.8)

    0.79

    Candidemia

    7 (11.7)

    2(6.9)

    5(16.1)

    0.42

    30 day mortality

    18(30)

    10(34.5)

    8(25.8)

    0.57

    Antifungal treatment

    52(86.7)

    24(82.8)

    28(90.3)

    0.46

    Duration of treatment--weeks

    4(2.5-6)

    53 patients treated

    3.88(+/-2.4)

    6.55(+/- 6.7)

    0.009

    Jonathan Williams, MD1, Odaliz Abreu Lanfranco, MD2, Juan Lemos-Ramirez, MD1, Pallavi Bhargava, MD1, George Alangaden, MD, FIDSA3 and Mayur Ramesh, MD2, (1)Infectious Disease, Henry Ford Healthcare System, Detroit, MI, (2)Infectious Diseases, Henry Ford Hospital, Detroit, MI, (3)Wayne State University, Detroit, MI

    Disclosures:

    J. Williams, None

    O. Abreu Lanfranco, None

    J. Lemos-Ramirez, None

    P. Bhargava, None

    G. Alangaden, None

    M. Ramesh, None

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