Independent Risk Factors For Candidemia Research Articles

481. Risk Factors and Clinical Outcomes of Candidemia Associated with Severe Coronavirus Disease 2019 (COVID-19)

Abstract Background COVID-19 can cause serious illness requiring multimodal treatment of the viral infection and its associated complications, including the potential for secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear. Methods A multi-center, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 to August 2021. Risk factors associated with candidemia and mortality were characterized using multivariate analyses. Results A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 patients with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of all patients received biologic for COVID-19. In-hospital mortality was significantly higher in the case group compared to the control group (68% vs 40%, P < 0.01). Multivariable logistic regression revealed that the use of central lines, biologic and paralytic therapy were independent risk factors for candidemia. The presence of candidemia, older age, central line use, and intensive care unit admission were significantly associated with mortality. Demographics and Baseline Characteristics of Study Patients with SARS-CoV-2 Positive With or Without Candidemia Hospitalization Details and Outcomes Conclusion Clinicians should be aware of the possibility of development of candidemia in hospitalized older patients with severe COVID-19 and should closely monitor those patients at risk. Risk factors for developing candidemia in the setting of COVID-19 are largely consistent with classic risk factors previously identified. Disclosures Tanaya Bhowmick, MD, Gilead: Grant/Research Support|Shinogi: Advisor/Consultant Steven Smoke, PharmD, BCPS, BCIDP, Karius: Advisor/Consultant|Shionogi: Advisor/Consultant.

Development and validation of COVID-19 associated candidemia score (CAC-Score) in ICU patients.

BackgroundThe development of candidemia is a highly fatal condition in severe COVID‐19 infection.ObjectivesThis study aimed to develop a candidemia prediction score in COVID‐19 patient based on the patient's clinical characteristics, and healthcare‐related factors during intensive care units (ICU) follow‐up.Patients/MethodsSevere COVID‐19 patients hospitalised in ICU in Ankara City Hospital during the one‐year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score.ResultsOf 1305 COVID‐19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12–44.8, p < .0001), multifocal colonisation (OR 2.28, CI 1.39–3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42–5.44, p < .0001) and corticosteroids (OR 0.51, CI 0.34–0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81–0.87).ConclusionWe developed and validated an easy‐to‐use clinical prediction score for candidemia in severe COVID‐19 infection. In COVID‐19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.

Opportunistic Candida Infections in Critical COVID-19 Patients.

The frequency of opportunistic fungal infections in critically ill patients whose intensive care unit stays are prolonged due to coronavirus disease 2019 (COVID-19) is higher than in the period before COVID-19. We planned this study to improve the management of Candida infections by defining the Candida species, the etiology of infections caused by Candida species, and the antifungal susceptibility of the species. This retrospective study included patients older than 18 hospitalized in the intensive care unit (ICU) with a definitive diagnosis of COVID-19 for seven months (from March 2021 to September 2021). All study data that we recorded in a standard study form were analyzed with TURCOSA (Turcosa Analytics Ltd. Co., Turkey, www.turcosa.com.tr) statistical software. The patients were evaluated in four groups as group 1 (candidemia patients, n = 78), group 2 (candiduria patients, n = 189), group 3 (control patients, n = 57), and group 4 (patients with candidemia in urine cultures taken before Candida was detected in blood culture, n = 42). Candida species were identified using both conventional and VITEK® 2 (BioMérieux, France) methods. The antifungal susceptibility of fungi was determined using the E test method. Of the 5,583 COVID-19 patients followed during the study period, 78 developed candidemia, and 189 developed candiduria. The incidence of candidemia (per 1,000 admissions) was determined to be 1.6. As a result of statistical analysis, we found that Candida albicans was the dominant strain in candidemia and candiduria, and there was no antifungal resistance except for naturally resistant strains. Candida strains grown in blood and urine were the same in 40 of 42 patients. Mortality was 69.2% for group 1, 60.4% for group 2, and 57.8% for group 3. Antifungals were used in 34 (43.5%) patients from group 1, and 95 (50.2%) from group 2. In the candidemia group without antifungal use, mortality was quite high (77.2%). Antifungal use reduced mortality in the group 2 (p < 0.05). Length of ICU stays, comorbidity, broad-spectrum antibiotics, and corticosteroids are independent risk factors for candidemia in critically ill COVID-19 patients. Our study contributes to the knowledge of risk factors for developing COVID-19-related candida infections. The effect of candiduria on the development of candidemia in critically ill COVID-19 patients should be supported by new studies.

Risk factors for candidemia: A case–control study

Background:Candida bloodstream infections (candidemia) have significant mortality and morbidity rates, as well as healthcare cost implications. Emerging multidrug-resistant Candida spp such as Candida auris, as well as increasing resistance among non–albicans species, which are becoming more prevalent, also raise concern. Understanding the epidemiology of this infection could enhance prevention and management efforts. We studied risk factors for candidemia. Methods: This matched case–control study was conducted at a university hospital from December 2019 through May 2021. Cases of candidemia were identified using positive blood-culture results. Controls were matched 5:1 to cases by age, sex, and month and year of admission. Risk factors of interest included total parenteral nutrition (TPN), central venous access (CVA), neutropenia, Clostridium difficile, pancreatic disease, Candida in urine culture, cancer, invasive procedures, H2 blockers, chemotherapy, antibiotic use, immunosuppression, and antifungal use. Bivariate conditional logistic regression models were used to study the association of individual factors with candidemia. Multivariable conditional logistic regression models were performed using factors with a P Results: Overall, 101 patients with candidemia and 505 matched controls were included. In the bivariate analysis, associations were detected between candidemia and TPN, CVA, pancreatic disease, invasive procedures, H2 blocker use, antibiotic use, and antifungal use (all Ps Conclusions: Associations of candidemia with recent antifungal use and pancreatic disease were relatively novel findings. Neutropenia was not an independent risk factor for candidemia in this study. Future directions include further evaluations of previous antifungal use in patients with candidemia to identify opportunities for possible intervention and antifungal stewardship.Funding: NoneDisclosures: None

Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study.

BackgroundWe evaluated the epidemiology of candidemia among coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs).MethodsWe conducted a retrospective multicenter study in Turkey between April and December 2020.ResultsTwenty-eight of 148 enrolled patients developed candidemia, yielding an incidence of 19% and incidence rate of 14/1000 patient-days. The probability of acquiring candidemia at 10, 20, and 30 days of ICU admission was 6%, 26%, and 50%, respectively. More than 80% of patients received antibiotics, corticosteroid, and mechanical ventilation. Receipt of a carbapenem (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 1.6–22.3, P = .008), central venous catheter (OR = 4.3, 95% CI = 1.3–14.2, P = .02), and bacteremia preceding candidemia (OR = 6.6, 95% CI = 2.1–20.1, P = .001) were independent risk factors for candidemia. The mortality rate did not differ between patients with and without candidemia. Age (OR = 1.05, 95% CI = 1.01–1.09, P = .02) and mechanical ventilation (OR = 61, 95% CI = 15.8–234.9, P < .0001) were independent risk factors for death. Candida albicans was the most prevalent species overall. In Izmir, Candida parapsilosis accounted for 50% (2 of 4) of candidemia. Both C parapsilosis isolates were fluconazole nonsusceptible, harbored Erg11-Y132F mutation, and were clonal based on whole-genome sequencing. The 2 infected patients resided in ICUs with ongoing outbreaks due to fluconazole-resistant C parapsilosis.ConclusionsPhysicians should be aware of the elevated risk for candidemia among patients with COVID-19 who require ICU care. Prolonged ICU exposure and ICU practices rendered to COVID-19 patients are important contributing factors to candidemia. Emphasis should be placed on (1) heightened infection control in the ICU and (2) developing antibiotic stewardship strategies to reduce irrational antimicrobial therapy.

Changing epidemiology and risk factors for candidemia in critically ill patients

Background/Aim: Candidemia is a common cause of bloodstream infections in critically ill patients, resulting in high mortality and morbidity. This retrospective case-control study was designed to identify epidemiological characteristics and risk factors for candidemia in an intensive care unit. Methods: A total of 166 patients hospitalized in the intensive care unit between January 2013 and December 2017 were included in this case-control study. Candidemia was defined as at least one positive blood culture for Candida spp. with fever or other clinical findings consistent with infection. Patients who acquired candidemia more than 48 hours after admission represented the case group (n=83). Control group (n=83) consisted of case-matching patients who were hospitalized during the same period and did not develop candidemia. Results: In the candidemia group Candida albicans (57.8%) was the most common species, followed by Candida glabrata (13.3%) and Candida parapsilosis (12%). The rate of C. albicans decreased from 69.2% to 50% during the five-year study period. Out of 83 candidemia infections, 36 (43.4%) were associated with central venous catheters. C. parapsilosis had an increasing rate in parallel with central venous catheter-associated candidemia rates. When comparing cases and controls, in univariate analysis, Sequential Organ Failure Assessment (SOFA) score, blood transfusion, central venous catheter placement, intubation, gastrointestinal surgery and total parenteral nutrition were significantly more common in the candidemia group (P<0.05 for each). The rate of the patients whose Candida scores were higher or equal to 3, was significantly higher in candidemia group (P=0.03). According to the multivariate analysis, SOFA scores (P<0.001, OR:1.25, 95% CI:1.15-1.37), gastrointestinal surgery (P=0.03, OR:2.60, 95% CI:1.10-6.12), central venous catheter (P=0.04, OR:2.62, 95% CI:1.05-6.57) and total parenteral nutrition (P=0.02, OR:2.61, 95% CI:1.12-6.06) were independent risk factors for candidemia, while enteral feeding (P=0.02, OR:0.27, 95% CI:0.09-0.80) was protective against. Conclusion: The result of our study is an evidence of the changing epidemiology of candidemia, which showed a shift towards non-albicans Candida spp. over the years. The increasing rate of C. parapsilosis and central venous catheter-associated candidemia has highlighted the need for more attention to the central line care and hand hygiene. Our study also revealed that critically ill patients with high SOFA score, gastrointestinal surgery, central venous catheter, and total parenteral nutrition have an elevated risk for developing candidemia. Unless necessary, limitation of total parenteral nutrition, and ensuring the earlier implementation of enteral feeding may be protective from candidemia.

Risk factors for candidemia: a prospective matched case-control study

BackgroundCandidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.MethodsThis prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.ResultsOne hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.DiscussionWhile this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).ConclusionThis study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology.

Epidemiological analysis of Nosocomial Candida infections: Experience of a university hospital

Objective: A retrospective investigation was made in a university hospital setting of the distribution of Candida infections in terms of species, different clinical features of infections, risk factors for candidemia caused by these fungi and their antifungal susceptibilities. Method: This study was conducted between January 1st 2014 and December 31st 2017. Patients included in the study were those diagnosed with candida infection as a result of candida species, isolated from at least one clinical sample of those taken from hospitalized patients, including blood, urine and other clinical samples, and who were then administered antifungal therapy. The identification of candida species was performed using Matrix-Assisted Laser Desorption/Ionization Time-of-Mass Spectrometry (MALDI-TOF MS). Results: During the study period, the candida infection rate was found to be 5.86% in the 2760 episodes of infection and the incidence of candida infection was found to be 0.35 in 1000 bed days. The most common infection site for candida was the urinary tract (61.1%), followed by the blood-stream (31.5%). In 66% of all candida infections, Candida albicans was defined as the causative agent. The distribution of Candida glabrata , Candida tropicalis , Candida parapsilosis , Candida lusiteniae, Candida krusei and Candida kefyr were determined as 9.9%, 9.3%, 4.9%, 2.5%, 1.9% and 1.2%, respectively. The sensitivity to fluconazole and amphotericin B was determined as 97.2% and 99.1% in the C. albicans isolates, respectively. The sensitivity ratios for both fluconazole and amphotericin B were determined as 78.2% in the non-albicans strains. Multivariate logistic regression analysis showed that total parenteral nutrition (TPN) [Odds ratio (OR) 3.69, 95% Confidence interval, 1.595-8.570; p=0.002] was an independent risk factor for candidemia in patients with candida infection. Conclusions: C. albicans were the most encountered species in candida infections in our hospital. TPN was determined as an independent risk factor for the development of candidemia. Determinations of the species distribution of fungal infections and the antifungal sensitivity are important for the selection of effective treatment.

Role of Early Onset Neutropenia in Development of Candidemia in Premature Infants.

The aim of the study was to assess the effect of early-onset neutropenia (EON) on the development of candidemia in premature infants and evaluate other risk factors. This prospective study was carried out in a neonatal intensive care unit of Cairo University Hospital. Fifty neutropenic premature infants were matched to 50 non-neutropenics. Subjects were then regrouped into candidemics and non-candidemics to study other risk factors such as central venous catheters, mechanical ventilation, parenteral nutrition, drugs as corticosteroids and others. Candidemia was assessed by Bactec and then seminested polymerase chain reaction for culture negatives. Candidemia developed in 28 neutropenic preterms and in 8 non-neutropenics (odds ratio = 6.68, 95% confidence interval = 2.61-17.1, p <0.001). Risk factors for invasive fungal infection in univariate analysis included bacterial septicemia, mechanical ventilation, parenteral nutrition and steroid therapy. Independent predictors of candidemia in multivariate regression analysis included EON, mechanical ventilation and steroid therapy. EON is an independent risk factor for candidemia in premature infants.

Candidemia combined with bacterial bloodstream infection: analysis of clinical features and associated risk factors

To investigate the clinical characteristics of and risk factors for candidemia combined with bacterial bloodstream infection(BSI) by retrospective analysis of cases. The clinical data of cases diagnosed as candidemia combined with BSI confirmed by blood culture were compared with those of cases with mono-candidemia in Beiing Tongren Hospital from January 2009 to December 2011. A logistic regression analysis was performed to investigate the independent risk factors. Forty-two cases diagnosed as candidemia were analyzed including 14 cases of candidemia combined with BSI and 28 cases of mono-candidemia. Ten strains of gram-positive cocci and 4 strains of gram-negative bacilli were isolated from candidemia combined with BSI group.Six strains of C.albicans, 4 strains of C.glabrata, 3 strains of C.tropicalis and 1 strain of C.krosei were isolated. There was no C.parapsilosis isolated from candidemia combined with BSI group but 9 strains in the mono-candidemia group. The septic shock rate of the candidemia combined with BSI group was higher than that of the mono-candidemia group (12/14 vs 7/28, P = 0.000). The mortality rate of the candidemia combined with BSI group was higher than that of the mono-candidemia group (10/14 vs 15/28), but the difference did not reach statistical significance (P = 0.266).Four factors were found statistically different by univariate analysis, including hospitalization more than 4 weeks (P = 0.001), bacteremia before candidemia(P = 0.005), hematological tumor (P = 0.01) and abdominal infection (P = 0.001). Multivariate analysis showed that hospitalization more than 4 weeks was the independent risk factor. Gram-positive cocci were the predominant species and septic shock was more common in candidemia combined with BSI. Hospitalization more than 4 weeks was the independent risk factor for candidemia combined with BSI.

Changing pattern of Candida species in a neonatal intensive care unit

S ir : We were interested in an article which was posted 22 July 2010 ahead of print on the early on-line service of Medical Mycology [1]. While Yapar and colleagues noted in their report that Candida albicans was the most commonly recovered Candida species in 83 blood cultures, nonC. albicans Candida species, e.g., Candida tropicalis , Candida parapsilosis , Candida glabrata , were isolated in increasing frequency from adult patients. Collectively, the nonC. albicans Candida species were found to be associated with 43% of the cases of candidaemia in their study. The predictors of candidaemia included the presence of a urethral catheter, prior use of antibiotics, red blood cell transfusions and parenteral nutrition. Total parenteral nutrition was an independent risk factor for candidemia caused by C. albicans and nonC. albicans Candida species . We performed a retrospective, single centre study in the neonatal intensive care unit (NICU) of Ankara Sami Ulus Maternity, Childrens ’ Education and Research Hospital between January 2005 and December 2009 to assess the rate of invasive candidiasis among low birth weight premature newborns. During this period, 24 neonates with a mean gestational age of 30 weeks (range 24 – 36 weeks) and a mean birth weight of 1,455 g (range 780 – 2,470g) developed invasive candidiaemia, i.e., an overall incidence of 1.4% but with an increasing trend over the study period. All infections were acquired nosocomially and developed within a mean of 17.5 (range 6 – 53) days after birth. The four most frequent causative Candida species were C. parapsilosis (32%), C. pellucilosa (32%), C. albicans (22%) and C. glabrata (8%), that is nonC. albicans Candida species were the etiologic agents of 72% of the candidaemia cases in our series. C. albicans was the predominant species recovered between 2005 and 2008, whereas, nonC. albicans Candida species, particularly C. parapsilosis , were the most frequent species during the period 2008 – 2009. Risk factors for candidemia were total parenteral nutrition (87.5%), mechanical ventilation (62.5%), antimicrobial therapy (37.5%), central venous catheter insertion (29.2) and necrotizing enterocolitis (29.2%). The overall mortality due to candidemia in our patients was 4.2% (1 of 24 cases, Table 1).

Nosocomial candidemia in adults: Risk and prognostic factors

Summary Objective of the study Determination of the risk and prognostic factors for candidemias that develop in adult patients (in a general hospital patient population, intensive care unit [ICU] patients and patients with solid organ malignancy). Patients The risk factors for candidemia were investigated in 256 adult patients (≥ 18 years old). Patients and methods The risk and prognostic factors for candidemia were investigated in adult patients using a matched case-control design. Results We found that a total of 457 adult patients developed nosocomial candidemia in our hospital over the 12-year study period. Candida albicans (46.8%) was the most common etiological agent in candidemia, whereas C. parapsilosis (27%) was isolated as the second most frequent species. The ratio of C. glabrata was 3.8%. The risk factors for candidemia were investigated in 256 patients for whom full medical record information was available. Total parenteral nutrition (TPN) (OR 1.718; 95% CI 1.139–2.594, P = 0.01), antacid use (OR 1.841; 95% CI 1.239–2.735, P = 0.003) and candiduria (OR 2.095; 95% CI 1.213–3.617, P = 0.008) were detected as independent risk factors for candidemia among all affected patients. Removal of the central venous catheter (OR 1.976; 95% CI 1.219–3.202, P = 0.006) was protective against mortality. Conclusion Candiduria, and use of TPN were the most frequently encountered independent risk factors in almost all patient groups in our study as well as in other studies on this topic, so they should be taken into account in the evaluation of patients with suspicion of candidemia.

Evaluation of species distribution and risk factors of candidemia: A multicenter case-control study

This study was planned to determine the risk factors of candidemia, and the most common Candida species causing bloodstream infections. A case-control study which included adult patients was conducted over a 1-year period at tertiary-care educational hospitals in Turkey. A total of 83 candidemia episodes were identified during the study period. Candida albicans was the most common species recovered (45.8%) followed by Candida tropicalis (24.1%) Candida parapsilosis (14.5%) and Candida glabrata which was isolated from only four (4.8%) patients. Presence of a urethral catheter (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.09-5.19; P = 0.02), previous use of antibiotics (OR 2.61; 95% CI 1.05-6.46; P = 0.03), RBC transfusions (OR 2.14; 95% CI 1.16-3.94; P = 0.01) and parenteral nutrition (OR 4.44; 95% CI 2.43-8.11; P < 0.01) were found as independent risk factors for candidemia. TPN (Total Parenteral Nutrition) was an independent risk factor for both C. albicans and non-Candida albicans Candida species (P < 0.001). Most of the risk factors were invasive procedures and former medications. We conclude that a great number of candidemia cases are preventable by means of reduction of unnecessary invasive procedures and the use of antimicrobials.

Clinical Characteristics and Risk Factors for Nosocomial Candidemia in Medical Intensive Care Units: Experience in a Single Hospital in Korea for 6.6 Years

The aim of this study was to determine candidemia incidence among patients in a medical intensive-care unit (MICU) and the associated mortality rate and to identify risk factors associated with candidemia. We retrospectively performed a 1:3 matched case-control study of MICU patients with candidemia. Controls were matched for sex, age, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Candidemia incidence was 9.1 per 1,000 admissions. The most common pathogen was Candida albicans. Crude mortality was 96% among candidemia patients and 52% among controls (P<0.001). Mortality differed significantly between the groups according to Kaplan-Meier survival analysis (P=0.024). Multivariate analysis identified the following independent risk factors for candidemia: central venous catheterization (odds ratio [OR] = 3.2, 95% confidence interval [CI]=1.2-9.0), previous steroid therapy (OR=4.7, 95% CI=1.8-12.1), blood transfusion during the same admission period (OR=6.3, 95% CI=2.4-16.7), and hepatic failure upon MICU admission (OR=6.9, 95% CI=1.7-28.4). In conclusion, we identify an additional independent risk factor for candidemia, the presence of hepatic failure on MICU admission. Therefore, increased awareness of risk factors, including hepatic failure, is necessary for the management of candidemia.

Risk Factors for Candidemia in Pediatric Oncology Patients.

Abstract 4735 BackgroundCandida species are among the most common causes of bloodstream infection and are associated with significant morbidity and mortality, particularly in oncology patients. Few studies have identified the risk factors for candidemia in pediatric oncology patients. MethodsWe conducted a nested case-control study within a cohort of pediatric patients admitted to the oncology unit at a children's hospital between 2001 and 2004. A case was defined as a patient with a positive blood culture for Candida spp. As time at risk is an important confounding variable in nosocomial studies assessing antibiotic risk factors, we selected two controls per case based on incidence-density sampling. Demographic and clinical data were collected by medical record review. Assessment of exposures was focused on the 2 weeks prior to the development of infection (case)/study entry (control). Conditional multivariate analyses were performed to determine independent risk factors for candidemia. ResultsWe identified 45 oncology patients with candidemia during the study period. The most commonly isolated species were C. albicans (49%), C. parapsilosis (18%), C. glabrata (9%), and C. lusitaniae (9%). The median age of cases was 6.2 years (Interquartile Range (IQR): 2.9– 13.8 years). Median time to candidemia was 12 days (IQR: 4-22 days). There was no significant difference in mortality between cases (7%) and controls (7%). Independent risk factors for candidemia included receipt of aminoglycosides for >3 days (OR: 10.51, CI: 2.96, 64.43), receipt of total parenteral nutrition (OR: 13.82, CI: 2.48, 44.49), and Graft versus Host Disease (GVHD) (OR: 15.09, CI: 0.91, 250.24).Table 1:Oncologic DiagnosisOncologic DiagnosisControl (n = 90)Case (n = 45)p-valueSolid tumor19 (21%)12 (27%)REFAcute myelogenous leukemia19 (21%)2 (4%)0.069Acute lymphoblastic leukemia33 (37%)9 (20%)0.093Neuroblastoma3 (3%)11 (25%)0.031Lymphoma8 (9%)0 (0%)0.992Central nervous system tumor2 (2%)6 (13%)0.231Other6 (7%)5 (11%)0.706 ConclusionThe receipt of aminoglycosides for >3 days, use of TPN, and GVHD were independently associated with candidemia in pediatric oncology patients. These results may inform targeted interventions to reduce the risk of candidemia in pediatric oncology patients. Disclosures:Zaoutis:Merck & Co.: Research Funding; Cephalon: Research Funding; Enzon: Research Funding.

Epidemiology of nosocomial fungal infections, with emphasis on Candida species.

Currently, about 180 hospitals participate in the National Nosocomial Infections Surveillance (NNIS) system. From January 1980 through April 1990, 27,200 fungal isolates causing nosocomial infections were reported from these hospitals; Candida species accounted for 19,621 (72.1%) of these isolates. Immunocompromised patients are at particularly high risk for candidemia. In patients with acute lymphocytic leukemia, treatment with vancomycin and/or imipenem appears to be an independent risk factor for candidemia; colonization of stool by Candida species may be another important predisposing factor in these patients. Rapid detection of invasive candidemia in these high-risk patients is particularly important to the improvement of rates of survival. Methods for rapid detection, such as the measurement of mannan (the major cell-wall polysaccharide of Candida), may be useful for diagnosing invasive candidiasis and for monitoring the response of this infection to antifungal therapy. Further studies of risk factors and the development of new methods for rapid diagnosis and monitoring should help decrease the morbidity and mortality associated with nosocomial fungal infections.

Natural history of bloodstream infections in a burn patient population: The importance of candidemia

Because of a perceived increase in Candida bloodstream infections in our burn unit, we retrospectively reviewed all the microbiologic data and the medical records of 209 patients with burns admitted during a 42-month period. Twice weekly burn wound cultures demonstrated that Candida species were the tenth most frequently isolated organisms ( 69 191 patients, 36%). Despite the low frequency of isolation from burn wounds, Candida species were the most common organisms found in blood cultures and urine cultures. Of 49 patients with positive blood cultures, 16 (33%) had clinically significant culture growth of yeasts: Candida albicans, 12; Candida parapsilosis, 2; Candida tropicalis, 1; and Torulopsis glabrata, 1. Patients with candidemia were more likely than patients with blood culture growth of other organisms to have burn wound cultures that grew Candida ( 15 16 vs 21 33 , p = 0.02 ), larger burns (61% vs 38%, p < 0.001), and death (63% vs 27%, p = 0.02). Multivariate analysis demonstrated that the total number of blood cultures with microorganism growth and large burn size were the greatest independent risk factors for candidemia. These data demonstrate that yeasts are pathogens of major importance in patients with burns, suggesting that in patients with burns who have suspected sepsis and large burn injury or a previous bacteremia, strong consideration should be given to administration of amphotericin B initiation of empiric antibacterial therapy.

Risk Factors for Candidemia in Patients with Acute Lymphocytic Leukemia

Between 1983 and 1987 the overall incidence of candidemia at the Institut Gustave Roussy, a tertiary care referral hospital for patients with cancer, increased from 0.1% (7 of 6,801) to 0.32% (24 of 7,515) (P = .009). Because acute lymphocytic leukemia (ALL) was the most common underlying disease in patients with candidemia, risk factors for candidemia were analyzed in this subset of patients. A case-control study comparing the eight ALL patients who had candidemia with 18 ALL control patients revealed that previous bacteremia, prolonged neutropenia, prolonged fever, prolonged administration of antimicrobial agents, treatment with multiple antimicrobial agents, and a relatively high concentration of Candida organisms in stool were significant risk factors for candidemia. In a logistic regression analysis, however, only receipt of vancomycin and/or imipenem was identified as an independent risk factor for candidemia. Further analysis showed that administration of vancomycin promoted proliferation of Candida organisms in the gastrointestinal tract and that this proliferation was associated with an increased risk of candidemia.