Nosocomial Candidemia Research Articles

Establishment and Validation of a Nomogram Clinical Prediction Model for Nosocomial Candidemia: An 18-Year Retrospective Analysis.

Nosocomial candidemia is a life-threatening condition, and the incidence has increased in recent years. Thorough epidemiological data is still lacking in China. A retrospective cohort study was conducted to investigate the patients admitted to Zhongshan Hospital Xiamen University from 1 January 2004 to 31 December 2022. This study included 205 individuals who were diagnosed with candidemia as subjects. Additionally, 303 cases with blood cultures were negative during the same period and were from the same department as a control group. We randomly assigned them to the training and validation groups in a 7:3 ratio. The least absolute shrinkage and selection operator regression, univariate and multivariate logistic regression analyses were used to filtrate independent factors associated with nosocomial candidemia. A nomogram model was established based on the selected variables. Receiver operating characteristic (ROC) curve, calibration plots and decision curve analysis (DCA) were used to evaluate clinical utility. Two hundred and five nosocomial candidemia patients were reported, containing a high proportion of Candida albicans (n = 91,44.39%), followed by Candida parapsilosis (n = 40, 19.51%), Candida tropicalis (n = 37,18.05%), Candida glabrata (n = 23, 11.22%) and Candida guilliermondii (n = 9,4.39%). Multiple organ dysfunction syndrome (OR = 10.372, 95% CI: 4.745-24.14 P < 0.001), increased urea nitrogen of serum (OR=1.088,95% CI: 1.039-1.144 P<0.001), decreased albumin of serum (OR = 0.922 95% CI: 0.850-0.997 P=0.045), mechanical ventilation (OR=4.074,95% CI: 1.397-12.77 P=0.012), central venous indwelling catheter (OR=7.422,95% CI: 3.189-18.41 P<0.001) and solid tumor (OR = 3.036 95% CI: 1.276-7.359 P=0.012) were identified as independent risk factors of candidemia. The area under the curve (AUC) of the nomogram model was 0.925 (95% CI: 0.898-0.952) in the training group and 0.946 (95% CI: 0.881-0.963) in the validation group. The calibration curve revealed good agreement between the probability and the observed values. DCA indicated that this nomogram might be clinically beneficial. The nomogram including multiple organ dysfunction syndrome, elevated blood urea nitrogen, decreased albumin, mechanical ventilation, central venous indwelling catheter and solid tumor could provide reference value to clinicians for identifying nosocomial candidemia.

The Evaluation of Nosocomial Candidemia in Pediatric Intensive Care: A Single-center Study

The Evaluation of Nosocomial Candidemia in Pediatric Intensive Care: A Single-center Study

Innovative Biosensing Approaches for Swift Identification of Candida Species, Intrusive Pathogenic Organisms.

Candida is the largest genus of medically significant fungi. Although most of its members are commensals, residing harmlessly in human bodies, some are opportunistic and dangerously invasive. These have the ability to cause severe nosocomial candidiasis and candidemia that affect the viscera and bloodstream. A prompt diagnosis will lead to a successful treatment modality. The smart solution of biosensing technologies for rapid and precise detection of Candida species has made remarkable progress. The development of point-of-care (POC) biosensor devices involves sensor precision down to pico-/femtogram level, cost-effectiveness, portability, rapidity, and user-friendliness. However, futuristic diagnostics will depend on exploiting technologies such as multiplexing for high-throughput screening, CRISPR, artificial intelligence (AI), neural networks, the Internet of Things (IoT), and cloud computing of medical databases. This review gives an insight into different biosensor technologies designed for the detection of medically significant Candida species, especially Candida albicans and C. auris, and their applications in the medical setting.

474. Differences In Clinical Manifestation, Prognostic Factors, and Outcomes Between Patients With Community-onset And Nosocomial Candidemia

Abstract Background Candidemia is an invasive and deadly infectious disease. The associated risk factors of candidemia include immunosuppression, broad-spectrum antibiotics, catheters, glucocorticoids, critical illness, surgery, neonates, previous candida colonization, and illicit drug use. In previous studies, the characteristic of community-onset candidemia was distinct from nosocomial candidemia. Methods We selected patients who were admitted for equal or more than two days in Taichung Veterans General Hospital of Taiwan from 2015 to 2018 with electronic medical charts. The diagnosis of candidemia was defined as Candida species identified in blood cultures by commercial identification systems. We applied Kaplan-Meier survival curves with a log-rank test and built multivariate Cox proportional-hazards models for risk factors associated with in-hospital mortality. The purpose of this study is to investigate the difference in the characteristics, outcomes, and associated risks of death between community-onset and nosocomial candidemia. Results A total of 339 patients were included for analysis. The incidence was 1.50 per 1000 admission person-years. 64.60% of patients were male, and the mean age was 64.24-year-old. The characteristics of patients were similar in both groups except for the status of port-A, glucocorticoid usage, and diabetes mellitus. In the community-onset group, a higher proportion of C. glabrata and C. parapsilosis, but fewer C. albicans and C. tropicalis were identified than in the nosocomial group. The all-cause mortality rate was 55.75%. Multivariate Cox proportional-hazards model showed that nosocomial (hazard ratio; HR, 1.96; 95CI, 1.291 - 2.97 ; p =0.002), glucocorticoids within seven days before candidemia (HR, 1.68; 95CI, 1.21 -2.32, p = 0.002), and septic shock (HR, 1.85; 95CI, 1.292 - 2.641, p &amp;lt; 0.001) were associated with poor outcome whereas treatment with an echinocandin within two days after candidemia was a protective factor (HR, 0.65; 95CI, 0.466 - 0.911, p = 0.012). Survival curves analysis between community-onset candidemia and nosocomial candidemia A log-rank test was applied to assess the statistical significance, and a p-value less than 0.05 was considered statistically significant. Conclusion In conclusion, candidemia is a lethal disease with a better outcome noted in those with community-onset candidemia. Species diversity existed in both groups, and Early initiation of echinocandin therapy within two days could reduce 35% mortality. Disclosures All Authors: No reported disclosures.

349. Characteristics and Outcomes of COVID-19 Patients with Candidemia at a Community Teaching Hospital in Chicago - One Year Follow Up.

Abstract Background We previously reported an alarming increase in cases of nosocomial Candidemia at our hospital which were associated with acute COVID-19 infection (Abstract 287 IDWeek 2021). We reinstated mitigation strategies including staff education, line insertion check list and antimicrobial stewardship. 1041 patients with acute COVID-19 were admitted to our hospital in 2021 (January to December) and 6 out 12 cases (50%) of Nosocomial Candidemia were seen in patients with acute COVID-19 infection. We re-evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia. Methods We performed a retrospective chart review of the 6 patients with Candidemia and confirmed COVID-19 infection at our 292-bed community teaching hospital in Chicago, Illinois from January through December 2021. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients comparing both years. Results The average age of our study population was 71 years (older); 67% were male. The average hospital length of stay (LOS) was shorter 28 days. The mean time from admission to the development of Candidemia was slightly longer 18 days. Associated co-morbidities included cardiovascular diseases (CVD) in 83%, diabetes mellitus (DM), in 50%, and obesity in 50%. Treatments for COVID-19 included Steroids (100%), Remdesivir (50%) and Baricitinib (33%). All patients were managed in the intensive care unit (ICU) and 67% had a central in place at the time of Candidemia. Half of the patients (50%) required hemodialysis (HD); all patients were treated with multiple antibiotics. The average LOS in the ICU was 18 days (shorter). Despite antifungal treatment, 80% expired. Conclusion Incidence of Candidemia in acute COVID-19 infections decreased by 56% in one year after reinstating mitigation strategies in our hospital. However, Candidemia remains a menace in hospitalized patients with acute COVID-19 infection. Associated risk factors remain history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics, treatment with steroids (100%) and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia remains very high. Disclosures All Authors: No reported disclosures.

Epidemiology of Nosocomial Candidemia, Mortality, and Antifungal Resistance: 7-Year Experience in Turkey.

Candidemia is an important clinical condition that prolongs hospital stays and increases morbidity, mortality, and hospital costs. The aim of this retrospective study was to evaluate the epidemiological and microbiological characteristics of patients with candidemia between January 2013 and December 2019. Two hundred forty-one episodes of candidemia were observed in 230 patients, 45% of whom were female. The median age was 63 years, and 53.9% of the episodes were in the intensive care unit (ICU). Commonly observed predisposing factors for candidemia included antibiotic use (71.3%), urinary catheterization (56.3%), central venous catheter placement (50.3%), total parenteral nutrition (47.9%), solid-organ malignancy (46%), surgery (48.6%), chemotherapy (37%), and steroid treatment (25.5%). The crude mortality rate was 52.7%. A significant difference was found between survivors and non-survivors (P = 0.007) according to the Charlson Comorbidity Index. However, no statistically significant association was found between mortality and age, sex, surgical procedure, catheter-related candidemia, or Candida spp. infection. The most frequently isolated Candida sp. was C. albicans (51%). Overall resistance rates to fluconazole, voriconazole, caspofungin, micafungin, and flucytosine were 3.7%, 0%, 2.5%, 1.8%, and 1.8%, respectively. Consequently, there is a need for tests that provide higher success rates, rapid diagnosis of candidemia, and local epidemiological data on antifungal resistance.

P442 Bacterial and fungal infection in COVID-19 diagnosed cases in a tertiary care ICU setting in the wake of second wave in Kolkata, India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMFungal and bacterial infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided. To investigate the incidence of bacterial and fungal infection of hospitalized patients intensive care units with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study in a tertiary care hospital in Kolkata in the wake of second-wave in India. A retrospective study of hospitalized patients with confirmed SARS-CoV-2 by PCR was analyzed study in a tertiary care hospital in Kolkata in the wake of second-wave from February 2021 to October 2021. The records of 327 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens, and respiratory viral PCR panels were obtained from COVID-19 patients, respectively. The average APACHE II score of the patients was 28 ± 6. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteremia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteremia was identified in six patients (three Candida, two Enterococcus spp., and one Pseudomonas aeruginosa). All other community-acquired bacteremias (n = 16) were attributed to non-respiratory infections. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Opportunistic fungal infection was detected in 58 patients (17.37%) of 327 patients monitored in ICU with a COVID-19-positive diagnosis. Candida albicans was the opportunistic fungal agent isolated from most blood samples taken from COVID-19-positive patients. The mortality rate of COVID-19-positive patients with candidemia was 80%. While 2/3 patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Prolonged mechanical ventilation support was associated with the development of nosocomial candidemia and bacteremia. Parallel to the developments in the field of diagnosis and treatment, an increase in the incidence of fungal infections and the number of patients who are in the risk group for the development of opportunistic fungal infections have been observed in recent years. Among the hospitalized patients, those most at risk in terms of fungal infections are intensive care unit (ICU) patients. The rate of Candida infections amongst critical care patients is very and may pose severe mortality if not diagnosed, treated, and handled effectively, and promptly.

P373 Does biofilm forming capacity of Candida tropicalis vary with echinocandin susceptibility?

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectives Candida tropicalis is a common cause of nosocomial candidemia and candiduria. The role of biofilm formation in virulence and antimicrobial resistance in C. tropicalis remains under-investigated. We aimed to evaluate the biofilm-forming capacity of C. tropicalis isolates exhibiting resistance, borderline resistance, and sensitivity to echinocandins.MethodsThe echinocandin resistant, borderline resistant, and susceptible isolates of C. tropicalis were collected based on their minimum inhibitory concentration (MIC) values according to Clinical and Laboratory Standard Institute (CLSI) broth microdilution guidelines. The isolates were subjected to FKS1 gene sequencing. To estimate biofilm production, echinocandin resistant (n = 2), borderline resistant (n = 5), and susceptible isolates (n = 3) were seeded at the cell concentration of 1 × 10⁶ cells/mL in RPMI-1640 with 0.165 M MOPS in polystyrene 96-well microtiter plates and incubated for 24 and 48 h at 37°C. The biofilm was quantified by crystal violet/safranin-based spectrophotometric method and XTT (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) reduction assay. Statistical analysis was performed using one-way ANOVA with Bonferroni's post-hoc test for multiple comparisons among the groups.ResultsFKS1 sequencing analysis revealed S654P mutation in HS1 in both resistant isolates while isolates exhibiting borderline MIC to echinocandins carried wild-type FKS1 gene. Biofilm formation in borderline echinocandin-resistant C. tropicalis isolates was significantly (P <.005) higher compared with resistant and susceptible isolates. However, no significant difference in biofilm formation was noted among resistant and susceptible isolates.ConclusionThis study suggests differential biofilm-formation capacity among C. tropicalis isolates with reduced susceptibility to echinocandins. However, this warrants further studies before any definitive inference can be made.

Epidemiology and Risk Factors of Candidemia Among Hospitalized Patients in a Turkish Tertiary Care Hospital.

Candidemia, which constitutes 50 - 70% of invasive Candida infections, is an important clinical condition with high mortality and difficulty in diagnosis and treatment. Our objective was to determine the epidemiology, risk factors of candidemia, the distribution, and antifungal susceptibilities of Candida spp. responsible for candidemia among hospitalized patients in Gazi University Medical Faculty Hospital. This was a laboratory-based, prospective observational study conducted between 2009 and 2010. The definition of nosocomial candidemia was based on CDC criteria. All relevant demographic and clinical data were collected from patient files. Candida spp. were identified by API ID32C system. Antifungal susceptibility testing was performed using broth microdilution method according to CLSI. Seventy-one candidemia episodes were identified with the incidence of 0.94 cases/1,000 hospital admissions. C. albicans was isolated in 47.9% of the admissions and in 52.1% of non-albicans Candida admissions. Among the latter, C. parapsilosis and C. tropicalis were the most frequent species. The most common risk factors were use of antibiotics (94.4%), hospitalization in the last 1 month (93%), history of hospitalization in ICU (74.6%), and CVC use (70.4%). Abdominal surgery, urethral catheter insertion, and use of piperacillin/tazobactam was found to increase the risk of C. albicans. A history of hospitalization within the last 3 months increased the risk of developing candidemia with non-albicans Candida spp. In total, fluconazole resistance was 20% (24.2% for C. albicans and 16.2% for non-albicans Candida strains) and voriconazole resistance was 5.7% (12.1% for C. albicans and 0% for non- albicans Candida). This study provided a relevant source of information for the prediction of high-risk patients and the implementation of prevention strategies for nosocomial candidemia.

287. Characteristics and Outcomes of COVID-19 Patients with Candidemia at a Community Hospital in Chicago

Background1,416 patients with acute COVID-19 infection were admitted to our hospital in 2020. During that year we noticed an alarming increase in cases of nosocomial Candidemia: 26 versus an average of 2.8 cases per year over the previous 5 years. 19 of the 26 episodes (73%) of Candidemia occurred in patients who were admitted with acute COVID-19 infection. Recent reports suggest that hospitalized patients with COVID-19 are at increased risk for developing Candidemia, however their clinical characteristics, risk factors and outcomes have not been well described. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia. MethodsWe performed a retrospective chart review of 19 patients with Candidemia and confirmed COVID-19 infection at a 292-bed community teaching hospital in Chicago, Illinois from January through December 2020. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients. ResultsThe average age of our study population was 65 years; 68% were male. The average hospital length of stay (LOS) was 34 days. The mean time from admission to the development of Candidemia was 16 days. Associated co-morbidities included cardiovascular diseases (CVD) in 79%, diabetes mellitus (DM), in 68%, and obesity in 50%. Underlying kidney disease was present in 10%. Treatments for COVID-19 included convalescent plasma (53%), remdesivir (53%), steroids (52%) and tocilizumab (19%). All patients were managed in the intensive care unit (ICU) and 95% required multiple central line (CL) placements. Most of the patients (58%) required hemodialysis (HD); all patients were treated with multiple antibiotics. The average LOS in the ICU was 25 days. Despite anti-fungal treatment, 68% expired. The 28-day mortality was 50%. ConclusionThe occurrence of Candidemia in our hospitalized patients with acute COVID-19 infection was associated with a history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia is high. The development of strategies to mitigate the occurrence of nosocomial Candidemia in this population of patients is urgently needed.Disclosures All Authors: No reported disclosures

Oral dysbiosis exacerbates the virulence of Candida parapsilosis sensu stricto via up-regulation of the CPH2 biofilm master gene

Candida parapsilosis sensu stricto is the second to third most frequent cause of candidemia. Studies place this yeast as a frequent colonizer of niches of the oral cavity, predominantly in pathological conditions. We hypothesize that a buccal environment in dysbiosis enhances the virulence of C. parapsilosis sensu stricto. Objective: To evaluate at the phenotype and molecular level the production of biofilm in oral isolates of C. parapsilosis sensu stricto and correlate the results with the clinical origin (dysbiosis versus eubiosis). Material and methods: The biofilm-forming ability was compared in 50 oral isolates of C. parapsilosis sensu stricto obtained from patients with and without oral dysbiosis; by quantification of biofilm biomass and metabolic activity. The results were corroborated by optical and confocal fluorescence microscopy, and correlated with the transcriptional activity of CPH2, by RT-qPCR. The data were analyzed by Excel 2010, and InfoStat 2018, with a 95% confidence interval. Results: The metabolic activity in biofilm was significantly higher in oral dysbiosis relative to control (p = 0.0025). Basal expression of CPH2 increased 2.8 times more in oral dysbiosis related to the control condition and showed no significant differences with pathogenic isolates of this same yeast, derived from onychomycosis lesions. Conclusion: The oral cavity in dysbiosis increases the virulence of C. parapsilosis sensu stricto due to possible changes in epigenetic marks. This finding suggests that the oral cavity in dysbiosis may be an alternative route to the skin in the epidemiology of nosocomial candidemia.

Oral Dysbiosis Exacerbates Candida parapsilosis Sensu Stricto Biofilm Production via Up-Regulation of the CPH2 Biofilm Master Gene

Introduction: Candida parapsilosis sensu stricto is the second to third most frequent cause of candidemia. Studies place this yeast as a frequent colonizer of niches of the oral cavity, predominantly in pathological conditions. We hypothesize that a buccal environment in dysbiosis enhances the virulence of C. parapsilosis sensu stricto. Objective: To evaluate the phenotype and molecular level of the production of biofilm in oral isolates of Candida parapsilosis sensu stricto and correlate the results with the clinical origin (dysbiosis versus eubiosis). Materials and Methods: The biofilm-forming ability was compared in 50 oral isolates of Candida parapsilosis sensu stricto obtained from patients with and without oral dysbiosis; by quantification of metabolic activity. The results were corroborated by confocal fluorescence microscopy, and correlated with the transcriptional activity of CPH2, by RT-qPCR. The data were analysed by Excel 2010, and InfoStat 2018, with a 95% confidence interval. Results: The metabolic activity in biofilm was significantly higher in oral dysbiosis relative to control (p = 0.0025). Basal expression of CPH2 increased 2.8 times more in oral dysbiosis related to the control condition and showed no significant differences with pathogenic isolates of this same yeast, derived from onychomycosis lesions. Conclusion: The oral cavity in dysbiosis increases the virulence of C. parapsilosis sensu stricto due to possible changes in epigenetic marks. This finding suggests that the oral cavity in dysbiosis may be an alternative route to the skin in the epidemiology of nosocomial candidemia.

Fungemia in COVID-19 ICU patients, a single medical center experience.

A known proportion of patients who are admitted for the novel coronavirus disease 2019 (COVID-19) requires intensive care unit (ICU) level of care. Prolonged ICU stay is a risk factor for the development of nosocomial candidemia. The current study aimed to investigate the incidence and risk factors associated with the development of nosocomial candidemia among patients admitted to the ICU for COVID-19. Patients who developed nosocomial candidemia were identified, and their clinical course was reported. A 1:3 case control matching was used to identify non-candidemia patients who served as controls. 89 patients were admitted to the ICU for COVID-19 during the study period. The incidence of nosocomial candidemia was 8.9% (n = 8). Case-control matching identified 24 patients with similar disease severity at the time of ICU admission. Median time to first isolation of yeast was 26 days. Candidemia patients reported longer median ICU stay than controls. (40 vs. 10 days, p = .004). In hospital death rates were comparable in both groups (38% vs. 54%, p = .548). Prolonged mechanical ventilation support was associated with the development of nosocomial candidemia.

Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study

Introduction: Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. Objective: The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. Methods: We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. Results: A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, p = 0.050). Conclusion: Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.

Attributable mortality of candidemia after introduction of echinocandins.

Candidemia is among the most frequent nosocomial bloodstream infections. Landmark case-control studies on amphotericin B and fluconazole estimated attributable mortality rates of 38% and 49%, respectively. After introduction of echinocandins, these may have decreased. In a case-control design, 100 consecutive, hospitalised patients with candidemia were enrolled at the University Hospital of Cologne, Germany between 2014 and 2017. Controls were patients without candidemia matched for age, sex, year and duration of hospitalisation, main admission diagnosis and Patient Clinical Complexity Level (PCCL). Main data captured were risk factors for candidemia, attributable mortality rates and diagnostic and therapeutic adherence according to the EQUAL Candida score. Overall mortality rates for cases and controls were 43% and 17% (P<.001), respectively; day 30 mortality rates were 38% and 11% (P=.03), accounting for an attributable mortality of 26% and 27%. Guideline adherence was higher in surviving vs non-surviving patients: while survivors reached a median of 17 (IQR: 16-19) points, non-surviving cases reached a median 16 (IQR: 14-18) points out of 22 maximum achievable points (P=.028). Risk factors for candidemia were more frequent in cases compared to control patients, especially chronic pulmonary disease (25% vs 16%; P=n.s.), chronic liver disease (21% vs 6%; P=.002), stay on intensive care unit (70% vs 64%; P=n.s.), respiratory failure (56% vs 50%; P=n.s.) and central venous catheter (97% vs 35%; P<.001). Attributable mortality of nosocomial candidemia is still substantial but has decreased compared to previous studies with similar design.

Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran.

Nosocomial bloodstream candidaemia is a life-threatening fungal infection with high morbidity and mortality, especially among paediatric patients undergoing intensive immunosuppressive therapy. Limited data on the epidemiology of candidaemia and susceptibility profiles are available for Iran. To characterise candidaemia epidemiology, comorbidity risk factors, species distribution, and antifungal susceptibility profiles among paediatric patients in Iran. This observational cross-sectional study enrolled 26189 patients <18years old at three reference paediatric hospitals in Mazandaran and Tehran over 2years. Blood samples from patients with suspected fungal bloodstream infection were analysed using the BACTEC culture system. Fungal isolates were identified using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF) and DNA sequencing. Antifungal susceptibility testing was performed using the Clinical and Laboratory Standards Institute broth microdilution guideline. We observed 109 episodes of nosocomial candidaemia in paediatric patients with or without immunosuppressive therapy. The most common healthcare-associated factor was central vascular catheter use (97%). The all-cause mortality rate was 40%, of which 48% was attributable to candidaemia. While Candida albicans was the most frequent causative agent (49%), emerging and uncommon Candida species were also isolated. Candidaemia mortality by non-albicans Candida species was significantly higher than that by C. albicans (P<.05). All fluconazole-resistant species were non-albicans Candida species. Uncommon Candida species with reduced susceptibility to antifungals are emerging as major agents of nosocomial candidaemia in high-risk paediatric patients in Iran. Appropriate source control, antifungal regimens and improved antifungal stewardship are warranted for managing and decreasing the burden of nosocomial candidaemia.

Analysis of 144 pediatric nosocomial candidaemia episodes over a four-year period

Analysis of 144 pediatric nosocomial candidaemia episodes over a four-year period

Investigation of a candidemia outbreak caused by C. parapsilosis in a pediatric hematology/oncology center

Objective. To investigate a candidemia outbreak caused by C. parapsilosis in a clinical unit of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology (NMRC PHOI). Materials and Methods. A total of 35 isolates of C. parapsilosis obtained from clinically significant specimens and swabs, including hands of nursing staff of the NMRS PHOI, over the 2018-2020 were genotyped in this retrospective study. Identification of C. parapsilosis isolates was performed by microbiological methods. The clonal structure of C. parapsilosis isolates was investigated by polymerase chain reaction followed by fragment analysis of microsatellite repeats (short tandem repeats, STR markers). Results. The results of the study showed genetic diversity of the population of C. parapsilosis isolates over the 2018–2020 in the NMRC PHOI. A total of 27 genotypes were identified, one of which caused candidemia in 6 patients. Conclusions. The study results confirmed the nosocomial candidemia outbreak and showed the fragment analysis of STR-markers may be used for epidemiological investigations of outbreaks in hospital settings.

1979. Five-Year Impact of an Antimicrobial Stewardship Program on Nosocomial Candidemia: An Interrupted Time-Series Analysis Study

BackgroundAntimicrobial stewardship programs allow a reduction in antibiotic prescription and, consequently, in the incidence of multidrug-resistance infections. However, the impact on nosocomial candidemia is still unclear.MethodsThe present study is an interrupted time-series (ITS) before-after study, based on an ecological time-trend analysis. Since 2014, an antimicrobial stewardship program (ASP) has been implemented at an Italian tertiary-care hospital. The first objective of the program was to reduce carbapenem consumption, through an active and computerized surveillance of all carbapenem prescriptions, each of which was checked and validated by ID specialists always after audit of the cases with treating physicians. We retrospectively evaluated the changing in the consumption of antimicrobials, carbapenems, and in the incidence of candidemia, during two study periods: before (2007–2013) and after (2014–2018) the implementation of the ASP.ResultsThe implementation of ASP was followed by a significant decrease in antibiotic consumption, which was consistent through the following 5 years. At the end of the study, total antibiotic consumption has decreased by 38.476 DDDs per 100 patient-days (PDs) per quarter (95% CI: −21.784 to −55.168; P < 0.001) and carbapenems decreased by 4.452 DDD per 100 PDs per quarter (95% CI: −3.658 to −5.246; P = 0.001). After 5 years of ASP, incidence of candidemia decreased by 2.034 episodes per 1,000 PDs per quarter (95% CI: −0.738 to −3.330; P = 0.003), decreasing, at the end of 2018, by 53% compared with the expected value if the program had not been implemented.ConclusionAt our Institution, the ASP had a positive impact on the consumption of carbapenems, and antimicrobials. The incidence of candidemia was also favorably affected by the program, reversing the trend after 2014. The ASP, even if not directly targeted to fungal infections, indirectly caused a reduction in the incidence of candidemia, probably reducing the number of patients colonized by Candida spp.Disclosures All authors: No reported disclosures.

Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study.

Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially when compared to C. parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). Multivariate analysis showed that older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.