Epidemiology, Risk Factors and Outcomes of Candida Empyema: A 5-Year Single-Centered Experience

Abstract

Background Candida empyema is a rare manifestation of invasive candidiasis and can occur as a result of candidemia or direct inoculation of the pleural space after thoracic or abdominal surgeries. The risk factors and outcomes of candida empyema are poorly defined.Methods We performed a retrospective descriptive analysis of all patients that had Candida species isolated from pleural fluid, from May 2012 to April 2017 at our institution.ResultsSixty patients with Candida empyema were identified. Patient characteristics are shown in Table 1. The majority of patients 68% had contiguous surgery and 25% had recent solid organ transplantation most of these were lung/heart transplants. The majority isolates were non-Candidia albicans species (52%). Fifty-two patients (86.7%) received antifungals treatment for empyema: 72% received an azole and 13% received an echinoncandin. Fluconazole was the most frequent antifungal (63.3%). Mean duration of treatment was 4 weeks. Of these patients 78% underwent chest tube drainage (40% before diagnosis, 39% after diagnosis) and 22% required VATS/decortication. The overall 30-day mortality was 30%. Candidemia was noted in seven patients (11.7%). Thirty-day mortality was associated with sepsis OR 1.04–11.4, P = 0.049, history of diabetes P = 0.045 and sepsis at the time of candida isolation. A history of solid organ transplantation had a negative effect on mortality OR 0.01–1.07.Conclusion Candida empyema was associated with recent contiguous surgery in the majority of cases including lung/heart transplants. Candida empyema is associated with significant mortality despite antifungal treatment and drainage as was associated with sepsis syndrome and diabetes.Variable N = 60 Candida albicans 29 (48.3%)Non-Candida albicans 31 (51.7) P-valueGender: male40 (66.7)20(69)20(64.5)0.78Malignancy16 (26.7)7 (24.1)9 (29)0.77Procedure within 1 year41 (68.320 (69)21(67.7)0.99Transplant15(25)6 (20.7)9 (29)0.56Sepsis at time of infection31(51.7)14(48.3)17(54.8)0.79Candidemia7 (11.7)2(6.9)5(16.1)0.4230-day mortality18(30)10(34.5)8(25.8)0.57Antifungal treatment52(86.7)24(82.8)28(90.3)0.46Duration of treatment, weeks4(2.5–6) 53 patients treated3.88( 2.4)6.55( 6.7)0.009Disclosures All authors: No reported disclosures.