366. Impact of Obesity in Patients with Candida Bloodstream Infections
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Candidemia contributes to prolonged hospitalizations, increased cost, and increased morbidity and mortality. Obesity worsens clinical outcomes for bacterial infections, though little is known about fungal infections. The purpose of this study was to assess if clinical outcomes differ in obese versus non-obese patients with candidemia.

Methods: This retrospective cohort study examined adult inpatients diagnosed with candidemia receiving >48 hours of antifungal therapy from June 2013 to December 2017. Patients with polymicrobial infections, dual systemic antifungal therapy, and chronic candidiasis were excluded. Obesity was defined as BMI ≥30 kg/m2. The primary outcome was infection-related length of stay. Secondary outcomes included time to bloodstream sterilization and in-hospital mortality.

Results: Eighty patients were included: 28 obese and 52 non-obese. Median [IQR] age was 54 [39-63]; 55% males. Median weight was 103 [91-111] kg in obese patients vs. 61 [51-73] kg in non-obese patients (p<0.01). There were no differences in comorbidities (Charlson 3[1-5] obese vs. 3[1-5] non-obese; p=0.72) or disease severity (Pitt bacteremia score 1[0-3] obese vs. 1[0-3] non-obese; p=0.50). C. albicans (37.5%) and C. glabrata (30.0%) were the most frequently isolated species. Source control (34%) and time to source control (30 h) were similar between groups, but ID consultation was more frequent in obese patients (82.1% vs. 55.8%; p=0.02). Obese patients were more likely to receive micafungin as definitive therapy (57.1% vs. 21.2%; p<0.01) with quicker initiation of definitive therapy (13h vs. 51h; p=0.03). Duration of candidemia was 6[4.8-7] and 5[3-6] days in obese and non-obese patients (p=0.02). Both infection-related and total hospital lengths of stay were longer for obese patients at 19[10-42] vs. 12.5[8-19] (p=0.05) and 30.5[15-52] vs. 22[12-39] (p=0.19), respectively. In-hospital mortality was similar (obese: 21.4%, non-obese: 13.5%; p=0.36).

Conclusion: Despite quicker receipt of definitive antifungal therapy, more frequent ID consultation and echinocandin usage, obese patients had longer duration of candidemia, increased infection-related length of stay, and numerically higher mortality.

Katie E. Barber, PharmD, Jamie L. Wagner, PharmD, Jennifer Miller, PharmD Candidate, Emily Lewis, PharmD Candidate and Kayla R. Stover, PharmD, BCPS, University of Mississippi School of Pharmacy, Jackson, MS


K. E. Barber, None

J. L. Wagner, None

J. Miller, None

E. Lewis, None

K. R. Stover, None

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