806. Candida Gut Colonization in Critically Ill Patients

Abstract

Abstract Background Candida spp. colonization is a risk factor for candidemia in intensive care unit (ICU) patients. Recent data suggest that the epidemiology of Candida infections is shifting away from C. albicans, but prospective data on the epidemiology of Candida spp. gut colonization are limited. Methods We conducted a prospective cohort study of adult patients admitted to an ICU at a tertiary care hospital. Patients had stool samples collected twice weekly for up to four weeks or until ICU discharge. A convenience sample of stool samples was plated on CHROMagar Candida Plus for 48 hours. Colonies of different morphologies were isolated on Sabouraud dextrose agar and identified with MALDI-ToF. Results A total of 102 patients were included in the cohort. We performed screening for stool Candida colonization in 12 patients: 8 (67%) men, median age 65 (IQR 54.5-68.5). Three (25%) were in shock and eight (67%) required mechanical ventilation on ICU admission. In-hospital mortality was 25%. Seven patients (58%) were colonized with Candida at ≥1 time point (Figure 1). Of 30 total time points tested (median per patient=2, range 1-5), 15 (50%) were positive for Candida spp. Most time points (9/15, 60%) were positive for C. glabrata; 4/15 (27%) were positive for both C. glabrata and C. albicans. A minority (1/15; 7%) were positive for C. albicans and C. parapsilosis alone, respectively. None had C. auris colonization. Most colonization was persistent: Of 6 colonized patients with ≥1 time point tested, 5 (83%) were colonized at multiple timepoints. Eleven patients had data collected on anti-fungal administration during the study period, and five of these received an antifungal (Figure 1). Of these five, three (60%) had no Candida colonization. One lost C. albicans colonization but had persistent C. glabrata colonization despite azole therapy, and another developed C. parapsilosis colonization despite azole and amphotericin administration. Figure 1. Results of serial stool samples tested for Candida colonization per individual patient. Conclusion Most ICU patients in this study had Candida spp. gut colonization, commonly with intrinsically azole-resistant C. glabrata. This study is limited by small sample size, and further data are needed to determine the clinical impact of antifungal-resistant Candida in ICU patients at high risk of candidemia. Disclosures All Authors: No reported disclosures