383. An Increased Rate of Candida parapsilosis Infective Endocarditis is Associated with Injection Drug Use
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall

Background:  C. parapsilosis (Cp) fungemia typically occurs in patients (pts) with intravascular catheters or prosthetic devices.  In 2017, we noted an increase in Cp infective endocarditis (IE).   

Methods:  We retrospectively reviewed Cp fungemia and IE from 1/2015-2/2018.  Species were identified using MALDI-TOF, and confirmed by ITS sequencing. 

Results:  Between 2010-2017, there was no increase in cases of Cp fungemia (mean: 13/year), but there was a significant increase in Cp IE (p=0.048) (Fig. 1).  From 1/2015-2/2018, 22% (12/54) of Cp fungemia was complicated by IE.  Demographics of Cp fungemia included: community-acquired infection (87%), presence of vascular catheters (80%), opiate non-injection drug use (non-IDU, 44%), IDU (20%), and presence of cardiac devices (18%).  91% (49/54) of Cp fungemia was caused by Cp sensu strictu (Cpss); C. orthopsilosis (Co) and C. metapsilosis (Cm) accounted for 4% (2/54) each (1 isolate could not be subtyped).   Cpss, Co and Cm accounted for 83% (10/12), 8% (1/12) and 8% (1/12) of IE, respectively.  92% (11/12) of Cp IE was left-sided, and 33% (4/12) involved multiple valves. Risk factors for Cp IE were past or active IDU (p<0.001), community-acquired fungemia (p=0.02), prosthetic heart valve (p=0.01) or implanted cardiac device (p=0.03). Receipt of an antibiotic within 30 days was a risk for Cp fungemia without IE (p=0.001).  Median age for IE vs fungemia was 38 vs 57 yrs (p=0.09). By multivariate logistic regression, IDU (p<0.0001), prosthetic valve (p=0.006) or implanted cardiac device (p=0.04) were independent risks for Cp IE.  70% (7/10), 20% (2/10) and 10% (1/10) of pts with IDU and Cp IE primarily used heroin, buprenorphine/naltrexone, and cocaine, respectively.  50% (6/12) of pts with CP IE underwent surgery; most common initial AF regimens were caspofungin and amphotericin B. Non-surgical pts were suppressed with long-term azole; one relapsed requiring surgery. 30-day- and in hospital mortality for pts with fungemia vs IE were 32% vs 17% and 26% vs 17%, respectively.

Conclusion:  Cp IE has emerged at our center.  Unique aspects of Cp pathogenesis that may account for emergence are a propensity to colonize skin, adhere to prosthetic material and form biofilm.  Cp IE may be an under-appreciated consequence of IDU and opioid abuse. 

J. Alexander Viehman, MD1, Cornelius J. Clancy, M.D.2, Guojun Liu, BS1, Shaoji Cheng, MD, Ph.D1, Louise-Marie Oleksiuk, PharmD3, Ryan K. Shields, PharmD1 and Minh-Hong Nguyen, MD1, (1)Infectious Disease, University of Pittsburgh, Pittsburgh, PA, (2)Infectious Disease, University of Pittsburgh and VA Pittsburgh, Pittsburgh, PA, (3)Pharmacy and Therapeutics, UPMC Presbyterian Shadyside, Pittsburgh, PA


J. A. Viehman, None

C. J. Clancy, None

G. Liu, None

S. Cheng, None

L. M. Oleksiuk, None

R. K. Shields, None

M. H. Nguyen, None

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