368. COMMUNITY-ONSET CANDIDEMIA: TRENDS OVER SEVEN YEARS
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Witherell IDSA-18-Candidemia-edited- 9-19-18 am, kr FINAL.pdf (638.7 kB)
  • COMMUNITY-ONSET CANDIDEMIA: TRENDS OVER SEVEN YEARS

    Rebeca Witherell, Babak Hooshmand, Kathleen Riederer, Leonard B Johnson, Riad Khatib,

    Background: Candidemia is often hospital acquired. With the inpatient-outpatient shift in healthcare, many cases are acquired in the community. We present a review of community-acquired candidemia.

    Methods: We reviewed blood culture results (1/1/2010-12/31/2017), selected patients with candidemia, defined the place of onset (community onset [CO]: 0-3 days after admission; hospital onset [HO]: ≥4 days), the source and species distribution and compared CO and HO cases. 

    Results: We encountered 210 candidemia episodes. The rate of candidemia (0.6-1.2/1000 discharges) and species distribution fluctuated without a clear trend. CO accounted for 92 (43.8%) episodes including 83 healthcare-related (CO-HC) and 9 (4.3%) without healthcare exposure (CO-A). CO/HO proportion did not significantly change over time. Source and species distribution were similar in CO and HO cases except for higher proportion of intravenous drug users (IVDA), soft tissue/bone (STB) sources and a trend toward more UTI in CO (table). Comparison of cases with C. albicans and C. glabrata revealed that C. glabrata was more common in diabetics (51.5 vs. 33.0%; p=0.005), and hemodialysis-dependent (H-D) cases (63.6% vs. 38.5; p=0.04), and tended to be less common in UTI (25.9% vs. 45.4% in other sources; p=0.09). 

    Conclusion: Candidemia remains a healthcare-related event but a significant portion is CO. CO-A is limited to IVDA and patients with comorbidities. Sources and species distribution was similar in CO-HC and HO cases except for more UTI in CO-HC. C. albicans remained more common but C. glabrata surpassed C. albicans among diabetics and H-D.

    Candidemia: comparison of CO-A, CO-HC and HO cases. Results represent. %

    Onset (n)

    Patient characteristics

    Source

    Candida Species

    CA

    DM

    H-D

    IVDA

    VA

    AB

    UTI

    STB

    O-U

    alb

    gla

    Other

    CO-A (9)

    11.1

    11.1

    0

    44.4

    0

    33.3

    22.2

    33.3

    22.2

    44.5

    33.3

    22.2

    CO-HC (83)

    25.3

    42.2

    21.7

    9.6

    32.5

    12.0

    22.0

    8.5

    25.6

    41.0

    36.1

    22.9

    HO (118)

    27.1

    34.7

    11.9

    5.1

    28.8

    21.2

    11.9

    3.4

    34.7

    47.5

    31.4

    21.1

    pa

    0.4

    0.9

    0.4

    0.002

    0.5

    0.5

    0.08

    0.004

    0.1

    0.5

    0.8

    0.8

    Cancer; diabetes; vascular; abdomen/pelvis; urinary tract; soft tissue/bone; other-unknown; albicans; glabrata; a: chi square test.

    Rebecca Witherell, MD, Babak Hooshmand, MD, Kathleen Riederer, MT, Leonard Johnson, MD and Riad Khatib, MD, Infectious Diseases, Saint John Hospital and Medical Center; Ascension, Grosse Pointe Woods, MI

    Disclosures:

    R. Witherell, None

    B. Hooshmand, None

    K. Riederer, None

    L. Johnson, None

    R. Khatib, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.