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

Disclosures:

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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