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.
K. E. Barber,
J. Miller, None
E. Lewis, None
K. R. Stover, None