Risk Factors for Candidemia as Compared with Patients with Negative Blood Cultures Placed on Empiric Micafungin

Abstract

Background Numerous risk factors have been linked to invasive candidiasis; however, they are nonspecific and often trigger empiric antifungal therapy in a large number of patients. Identification of more precise predictors could promote judicious use of empiric echinocandins. Ultimately, this could decrease antifungal exposure, development of resistance, and associated costs.Methods This was a retrospective review of patients admitted to Baylor University Medical Center from 10/1/14 to 10/25/16. Patients with positive blood cultures for Candida spp. were compared with a randomly selected cohort of patients on empiric micafungin for 3 or more days and with blood cultures negative for Candida spp. This study excluded patients on prophylactic antifungals and patients with positive abscess cultures but negative blood cultures for Candida spp. Data was analyzed using the χ 2 test, t-test comparing means, and logistic regression as applicable.ResultsThere were 127 patients with candidemia and 134 patients without candidemia on empiric micafungin. Factors associated with candidemia included positive 1,3-β-d-glucan assay (86.4% vs. 33.3%, P < 0.001), total parenteral nutrition (TPN) (26.0% vs. 15.7%, P = 0.040), and multifocal Candida colonization (35.3% vs. 4.5%, P < 0.001). Patients without candidemia on empiric micafungin were more likely to receive antibiotic therapy in the previous 10 days (55.9% vs. 79.9%, P < 0.001) and more likely to be taking immunosuppressive medications (11.0% vs. 30.6%, P < 0.001). There was no difference in mean length of stay (25.5 days vs. 27.3 days, P = 0.631) or 30-day all-cause mortality (32.3% vs. 23.9%, P = 0.131) between patients with candidemia and patients on empiric micafungin, respectively.Conclusion A negative 1,3-β-d-glucan assay in patients without multifocal Candida colonization or receiving TPN was inversely correlated with invasive candidiasis, as defined by candidemia. Therefore, the absence of these factors may be used to deescalate empiric micafungin therapy. Risk factors for candidemia identified in this study are consistent with previously published literature. These findings highlight an opportunity to improve empiric micafungin prescribing patterns at our institution.Disclosures All authors: No reported disclosures.