367. Influence of Body Weight and Outcomes in Candidemia
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Obese patients may have altered pharmacokinetic parameters when compared to normal weight patients due to their body habitus and altered drug clearance. Case reports suggest higher echinocandin dosing may be needed to reach adequate serum concentrations in obese patients. The purpose of this project is to compare patient outcomes between normal weight and overweight patients that receive an echinocandin for candidemia.

Methods: IRB approved, retrospective cohort at 5 hospitals with an antimicrobial stewardship program. Dates: 1/1/14 – 1/31/18. Included: ≥ 18 years, Candida species positive blood culture or T2MR, anidulafungin FDA label dose for ≥ 72 hours. Exclusion criteria: neutropenia, endocarditis, osteomyelitis, meningitis, immunosuppression. Primary outcome: 30 day all-cause mortality. Secondary outcomes: 14 day global clinical cure rates, Candida eye involvement, recurrence, antifungal restart, optimal azole dose.

Results: 173 patients included: 121 blood; 73 T2MR. Obese: more female, pulmonary disease. Underweight: less surgery. Most common species: C. albicans (33%), C. glabrata (33%). More C. parapsilosis in obese (36.4%). Low anidulafungin minimum inhibitory concentrations (MIC) in all groups, but elevated in C. parapsilosis. No association between body mass index and mortality: underweight (36.4%), normal (25.8%), overweight (32.0%), obese (33.9%), morbidly obese (31.8%). See table 1 for variables associated with mortality. No differences in quality of management, recurrence, Candida eye involvement, antifungal restart, optimal azole dose. More global cure in survivors.

Conclusion: We were unable to detect a difference in mortality in patients with candidemia by weight group. Line removal and receipt of ≥ 5 days of anidulafungin were protective.

Table 1

Survived, n (%)

N = 118

Died, n (%)

N = 55

Unadjusted OR [CI]

Adjusted OR [CI]

Echinocandin MIC ≥ 0.12 mcg/mL

11/29 (38)

0/5 (0)

0.8 [0.63 – 0.97]

-

Severe sepsis

73 (62)

46 (84)

3.1 [1.4 – 7.1]

5.1 [1.7 – 14.8]

Liver disease

10 (9)

13 (24)

3.3 [1.4 – 8.2]

3.2 [1.1 – 9.4]

Congestive heart failure

17 (14)

15 (27)

2.2 [1.0 – 4.9]

2.4 [0.9 – 6.6]

Echinocandin ≥ 5 days

68 (58)

21 (38)

0.45 [0.24 – 0.87]

0.35 [0.15 – 0.8]

Line removal

95/101 (94)

28/53 (53)

0.07 [0.03 – 0.19]

0.05 [0.02 – 0.2]

Mary Musgrove, PharmD, Pharmacy, Henry Ford Hospital, Detroit, MI, Rachel M Kenney, PharmD, Henry Ford Health-System, Detroit, MI, Susan Davis, PharmD, Henry Ford Health System, CFP#3, MI and Jose Vazquez, MD, FACP, FIDSA, Infectious Diseases, Augusta University Medical Center, Augusta, GA

Disclosures:

M. Musgrove, None

R. M. Kenney, None

S. Davis, Achaogen: Consultant and Scientific Advisor , Consulting fee . Allergan: Consultant and Scientific Advisor , Consulting fee . Melinta: Consultant and Scientific Advisor , Consulting fee . Nabriva: Consultant and Scientific Advisor , Consulting fee . Zavante: Consultant and Scientific Advisor , Consulting fee .

J. Vazquez, None

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