377. High Resistance and Mortality Rates in Patients with Ventricular Assist Device (VAD) Associated Candidemia: A Need for Alternative Antifungal Strategies
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: VADs are increasingly utilized in the management of end-stage heart disease. Infections are frequently encountered in VAD patients, are difficult to manage, and delay heart transplant. Prior studies have illustrated that fungal infections are rarer than bacterial infections but carry a higher mortality rate. Published data regarding the treatment and outcomes of fungal infections in VAD patients are scarceThe objective of this study was to describetreatment patterns, clinical outcomes and antifungal resistance rates in this unique patient population.

Methods: This was a retrospective cohort study that included VAD patients 18 years and older admitted to Baylor St. Luke’s Medical Center in Houston, TX between 2009 and 2016 with a positive blood culture for Candida spp. Patients with more than one Candida spp. isolated were excluded. Patient data was collected using electronic medical records and microbiology lab reports.

Results: Out of 835 VAD patients screened, there were 57 candidemia episodes across 38 patients resulting in an incidence of 6.2%. C. glabrata was the most common species (13/38, 34.2%), followed by C. albicans (10/38, 26.3%), C. parapsilosis (6/38, 15.8), C. tropicalis (5/38, 13.2%) and C. krusei (3/38 (7.9%). Ten patients had an echinocandin non-susceptible first isolate (26.3%). In patients with recurrent candidemia, echinocandin non-susceptibility rose as high as 55.6%. Candida species was the only independent risk factor for antifungal non-susceptibility (OR, 1.9; 95% CI, 1.0 – 3.4). Micafungin was the most common initial antifungal (34/38, 89.5%) but 7 patients required salvage therapy with amphotericin and/or combination therapy (18.4%). Nineteen patients died prior to discharge (50.0%) and 29 patients died within one year (76.3%). Independent risk factors for in hospital mortality included APACHE II score (OR, 1.4; 95% CI, 1.1 – 1.8) and persistent candidemia (OR, 12.9; 95% CI, 1.3 – 129.6). Only 3 patients survived to heart transplant (7.9%).

Conclusion: Resistance and mortality rates in this patient population are extremely high. Micafungin was the most common antifungal used but antifungal choice did not appear to impact one year mortality. While this is the largest cohort of patients with VAD associated candidemia to date, larger, prospective studies are needed to guide management of these infections.

Gary Fong, PharmD1 and Nicholas D. Beyda, PharmD, BCPS1,2, (1)CHI St. Luke's Health - Baylor St. Luke's Medical Center, Houston, TX, (2)Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX

Disclosures:

G. Fong, None

N. D. Beyda, Astellas: Grant Investigator and Scientific Advisor , Consulting fee and Research grant .

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