Parapsilosis Candidemia Research Articles

Clinical Characteristics of Candidemia Due to Candida parapsilosis with Serial Episodes: Insights from 5-Year Data Collection at a Tertiary Hospital in Korea.

Blood isolates of the C. parapsilosis complex were collected from February 2019 to January 2023 at a tertiary Korean hospital. Species identification was performed using Vitek 2 or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and antifungal susceptibility testing was performed using the Sensititre YeastOne® system. Clinical information was collected, and characteristics were analyzed according to single or serial isolates. A total of 586 blood isolates of the C. parapsilosis complex were recovered from 68 candidemia patients during the study period. Of them, only the first isolate per patient was investigated. The only two isolates were resistant to fluconazole and no isolate was resistant to echinocandins, amphotericin B, or 5-FC. A single episode of candidemia occurred in 35 patients, while serial episodes occurred in 33 patients. Underlying liver diseases, use of vasopressors, ICU admission, severe sepsis, and CVC use were more frequent in patients with serial episodes. There was no significant difference in the median MIC values of antifungal agents or the use of azoles or amphotericin B between single and serial episodes. However, patients with serial episodes more frequently received echinocandin therapy. Overall, there was no significant difference in the 30-day mortality rate between patients with single and serial episodes. Our data indicate that several factors related to the underlying conditions of the patients are associated with C. parapsilosis candidemia with serial episodes, rather than the characteristics of Candida itself.

Attributable mortality of candidemia – Results from the ECMM Candida III multinational European Observational Cohort Study

Despite antifungal advancements, candidaemia still has a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes of candidaemia for better understanding and management of these infections. In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with blood culture-proven candidemia. Collected data included patient demographics, risk factors, hospital stay duration (follow-up of 90 days), diagnostic procedures, causative Candida spp., management details, and outcome. Controls were included in a 1:1 fashion from the same hospitals. The matching process ensured similarity in age (10-year range), primary underlying disease, hospitalization in intensive care versus non-ICU ward, and major surgery within 2 weeks before candidemia between cases and controls. Overall and attributable mortality were described, and a survival probability for cases and controls was performed. One hundred seventy-one pairs consisting of patients with candidemia and matched controls from 28 institutions were included. In those with candidemia, overall mortality was 40.4%. Attributable mortality was 18.1% overall but differed between causative Candida species (7.7% for Candida albicans, 23.7% for Candida glabrata/Nakaseomyces glabratus, 7.7% for Candida parapsilosis and 63.6% for Candida tropicalis). Regarding risk factors, thepresence of a central venous catheter, total parenteral nutrition and acute or chronic renal disease were significantly more common in cases versus controls. Duration of hospitalization, and especially that of ICU stay, was significantly longer in candidemia cases (20 (IQR 10-33) vs 15 days (IQR 7-28); p=0.004). Although overall and attributable mortality in this subgroup analysis of matched case/control pairs remains high, the attributable mortality appears to have decreased in comparison to historical cohorts. This decrease may be driven by improved prognosis of Candida albicans and Candida parapsilosis candidemia; whereas candidemia due to other Candida spp. exhibits a much higher attributable mortality.

Candida parapsilosis candidemia in children admitted to a tertiary hospital in Turkey: clinical features and antifungal susceptibility.

It has been observed that the frequency and antifungal resistance of Candida parapsilosis have increased recently. In our study, we aimed to determine the antifungal sensitivity of C. parapsilosis and the clinical and demographic characteristics of children with candidemia. It was observed that the patients' history of malignancy, mechanical ventilation, urinary catheter, nasogastric tube, and intensive care stay was associated with C. parapsilosis mortality. The mortality rate from candidemia was 9.5%. The most frequently preferred antifungal agents were amphotericin B and fluconazole. The fluconazole drug resistance rate was found to be 6%, and the amphotericin B drug resistance rate was 4%. Because C. parapsilosis candidemia mortality rates can be high depending on risk factors and clinical characteristics, it is important to initiate appropriate and timely antifungal therapy.

Risk factors associated with fluconazole resistance in Candida parapsilosis candidemia: A case-case study.

Candida species are among the most important invasive pathogens in intensive care units (ICUs). Non-albicans species including Candida parapsilosis (C. parapsilosis) has increased in recent years. Fluconazole is the leading antifungal agent but resistance is a concern among C. parapsilosis species. The aim of this study was to determine the factors associated with fluconazole resistance in patients with candidemia due to C. parapsilosis in ICUs. This case-case study was conducted in a 750-bed, tertiary hospital between 2015 and 2021. Patients with fluconazole-resistant C. parapsilosis candidemia constituted the 'cases of interest' group and patients with fluconazole-susceptible C. parapsilosis candidemia constituted the 'comparison cases' group. Demographic and clinical data of the patients were recorded. Logistic regression analysis was performed using the backward elimination method to determine the independent predictors of fluconazole-resistant C. parapsilosis bloodstream infections. The study included 177 patients. In the cultures of these patients, 76 (43%) fluconazole-resistant, 13 (7.3%) fluconazole-reduced susceptible, and 88 (49.7%) fluconazole-susceptible isolates were found. In the regression analysis the risk factors for fluconazole-resistant C. parapsilosis bloodstream infection, malignancy, immunosuppressive treatment, history of intra-abdominal surgery, hypoalbunemia, previous fluconazole use, and SOFA score were found to be associated in univariate analysis. In multivariate regression analysis, history of intra-abdominal surgery (OR: 2.16; 95% CI: 1.05-4.44), hypoalbuminemia (OR: 2.56; 95% CI: 1.06-6.17) and previous fluconazole use (OR: 3.35; 95% CI: 1.02-11) were found to be independent predictors. In this study, a significant correlation was found between candidemia due to fluconazole-resistant C. parapsilosis in ICUs and intra-abdominal surgery, hypoalbuminemia, and previous fluconazole use. C. parapsilosis isolates and fluconazole resistance should be continuously monitored, strict infection control measures should be taken and antifungal stewardship programs should be implemented.

Invasive Candida parapsilosis Bloodstream Infections in Children: The Antifungal Susceptibility, Clinical Characteristics and Impacts on Outcomes

Background: Candida parapsilosis is the most common non-albicans candida species that causes invasive candidiasis, but little is known about its impacts on the outcomes of pediatric patients. We aimed to characterize the clinical characteristics, risk factors and outcomes of C. parapsilosis bloodstream infections (BSIs) in children. Methods: All pediatric patients with Candida parapsilosis BSIs between 2005 and 2020 from a medical center in Taiwan were enrolled and analyzed. The antifungal susceptibility, clinical manifestations, management and outcomes were investigated. Cases of Candida parapsilosis BSIs were compared between patients with C. albicans BSIs and other Candida spp. BSIs. Results: During the study period, 95 episodes (26.0% of total cases) of Candida parapsilosis BSIs were identified and analyzed. No significant difference was found between pediatric patients with C. parapsilosis BSIs and those with C. albicans BSIs in terms of patients’ demographics, most chronic comorbidities or risk factors. Pediatric patients with C. parapsilosis BSIs were significantly more likely to have previous azole exposure and be on total parenteral nutrition than those with C. albicans BSIs (17.9 vs. 7.6% and 76.8 vs. 63.7%, p = 0.015 and 0.029, respectively). The duration of C. parapsilosis candidemia was relatively longer, and therefore patients often required a longer duration of antifungal treatment when compared with those of C. albicans candidemia, although the candidemia-attributable mortality rates were comparable. Of the C. parapsilosis isolates, 93.7% were susceptible to all antifungal agents, and delayed appropriate antifungal treatment was an independent factor in treatment failure. Conclusions: Pediatric patients with C. parapsilosis BSIs were more likely to have previous azole exposure and be on total parenteral nutrition, and the clinical significances included a longer duration of candidemia and patients often required a longer duration of antifungal treatment.

Fluconazole-resistant Candida parapsilosis: A new emerging threat in the fungi arena.

Candida parapsilosis is a leading cause of invasive candidiasis in southern Europe, Latin America and Asia. C. parapsilosis has been mostly considered susceptible to triazoles, but fluconazole resistance is on the rise in some countries. The main mechanism related to fluconazole resistance is the presence of ERG11p substitutions, dominated by the Y132F amino acid substitution. Isolates harbouring this substitution mimic C. auris given that they may cause hospital outbreaks, become endemic, and emerge simultaneously in distant areas around the world. At the moment, Spain is experiencing a brusque emergence of fluconazole resistance in C. parapsilosis; isolates harbouring the Y132F substitution were detected for the first time in 2019.A recent study on Candida spp isolates from blood cultures collected in 16 hospitals located in the Madrid metropolitan area (2019 to 2021) reported that fluconazole resistance in C. parapsilosis reached as high as 13.6%. Resistance rates rose significantly during those three years: 3.8% in 2019, 5.7% in 2020, and 29.1% in 2021; resistant isolates harboured either the dominant Y132F substitution (a single clone found in four hospitals) or G458S (another clone found in a fifth hospital). The COVID-19 pandemic may have increased the number of candidaemia cases. The reason for such an increase might be a consequence of uncontrolled intra-hospital patient-to-patient transmission in some hospitals, as an increase not only in C. parapsilosis candidaemia episodes but also in the spread of clonal fluconazole-resistant isolates might have occurred in other hospitals during the pandemic period. Patients affected with fluconazole-resistant C. parapsilosis harbouring the Y132F substitution presented a mortality rate ranging from 9% to 78%, were mainly admitted to intensive care wards but did not have differential risk factors compared to those infected by susceptible isolates. With scarce exceptions, few patients (≤20%) infected with fluconazole-resistant isolates had previously received fluconazole, thus supporting the fact that, although fluconazole might have been a key factor to promote resistance, the main driver promoting the spread of fluconazole-resistant isolates was patient-to-patient transmission.

P027 Early warning bells: emergence of fluconazole resistance in Candida parapsilosis

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMPreeti S. Ajapuje¹, Parikshit S. Prayag¹, Bharat D. Purandare¹, Sampada A. Patwardhan², Shweta P. Panchakshari¹, Rajeev N. Soman¹Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune 2Department of Microbiology, Deenanath Mangeshkar Hospital, PuneObjectivesTo study the susceptibility patterns in blood isolates of Candida parapsilosis at a tertiary care center.MethodsThis was a retrospective observational study of nine cases of candidemia due to C. Parapsilosis over a period of 1 year. Data were collected using the hospital’s electronic health records. Species identification was done using Matrix-Assisted Laser Desorption and Ionization-Time of Flight Mass Spectrometry (MALDI-TOF-MS) (Bruker Biotyper Sirius-Bruker Daltonics, Bremen, Germany). Antifungal susceptibility was performed by broth microdilution method using Sensititre™ YeastOne™ YO1O AST Plates (Thermofisher Scientific, USA).ResultsAll patients with C. parapsilosis bloodstream infection had central venous access and all patients had received broad-spectrum antibiotics at the time of developing candidemia. Four patients developed C. parapsilosis candidemia in the post coronavirus disease 2019 (COVID 19) setting. Out of the 9 isolates, 7 (77.7%) were resistant to fluconazole, 2 were resistant to voriconazole and posaconazole, and 1 isolate was resistant to amphotericin. A total of 4/9 patients were started on fluconazole prior to antifungal susceptibility testing; 3 of these needed to be switched to an echinocandin due to fluconazole resistance.ConclusionFluconazole resistance in this study was seen in 7/9 (77.7%) isolates which is more than what has been previously described for C. parapsilosis. This makes fluconazole a poor choice for the treatment of C. parapsilosis in our institute. These findings may have an implication in the selection or de-escalation of antifungal treatment for C. parapsilosis.

P194 Disseminated fusariosis in h ematological malignancies with favo rable outcomes

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Fusarium is a serious fungal disease that mainly affects high-risk hematological patients. Early recognition of cutaneous entry of Fusarium in severely immunocompromised patients is critical to initiate early treatment.The aim of this presentation is to present two cases of disseminated fusariosis in severe oncohematological patients with favorable outcomes. Case 1: A 65-year-old man was admitted to the hospital for allogeneic hematopoietic cell transplantation. He had chronic myelomonocytic leukemia treated with cytosine analog antineoplastic and received pre-transplant prophylaxis with voriconazole 400 mg/day. On day 8 after transplantation, he presented pain and erythema on the fifth toe. Scarification of the digital intertrigo showed fine septate hyaline filaments. Antifungal treatment with voriconazole 400 mg/day plus liposomal amphotericin B 5 mg/k/d was administered. The patient remained severely neutropenic and the digital lesion progressed to painful necrosis for the following 12 days. BACTEC blood culture developed F. keratoplasticum and MIC (mg/L) amphotericin B 1, voriconazole 8 (CLSI M38-3rd Ed). On day 24 post-transplant, the patient presented an erythematous lesion on the right leg. A toilette of the digital lesion and a skin biopsy of the lesion on the right leg was performed, both of which showed fine hyaline filaments on direct examination with negative culture. On day 55, the patient was stable and amphotericin B was discontinued. He was treated with voriconazole 400 mg/d and had a good clinical evolution. The patient was discharged 65 days after transplantation. Case 2: An 18-year-old man was admitted to the hospital for chemotherapy treatment for acute lymphocytic leukemia (ALL). The patient received prophylaxis with fluconazole. On day 15 after chemotherapy, he developed Candida parapsilosis candidemia; C.parapsilosis MIC (mg/L) amphotericin B 1, fluconazole 0.5, voriconazole 0.015; anidulafungin 0.4 (E Def 7.32.EUCAST). The patient was treated with anidulafungin. He remained febrile and neutropenic. On the 19th day, he presented a digital intertrigo on the foot. Direct examination of the scarification of the interdigital lesion showed fine hyaline filaments and the colony was identified as F. solani complex, MIC (mg/L) amphotericin B 2, voriconazole 8 (M 38 3rd Ed CLSI). The antifungal treatment was changed to voriconazole 400 mg/d and lipid complex amphotericin B 5 mg/kg/d. On day 22, he was still neutropenic and febrile. Chest and sinus CT scans showed no abnormalities. Blood cultures and BAL culture were negative. The patient developed multiple ecthyma gangrenosum skin lesions on the torso and legs. On day 35, he received a granulocyte transfusion. On days 42 and 44, the serum GM Aspergillus was 0.2 and 0.4 respectively. On day 45, he presented a nasal lesion. The nasal biopsy showed a positive direct examination and development of the F. solani complex. On day 47, a surgical toilette of the foot lesion was performed. The patient had a favorable outcome with voriconazole 400 mg/day until hematopoietic cell transplantation.ConclusionEvaluation of skin lesions in severely immunocompromised patients allows prompt diagnosis for antifungal treatment and appropriate debridement in patients with a proven mycological diagnosis of disseminated fusariosis.

Comparison of Crystal Violet Staining Assay and XTT Methods in the Evaluation of Biofilm Formation in Candida parapsilosis Candidemia Isolates

Biofilm formation is one of the most important virulence factors for Candida species. Biofilm can be defined as a whole microbial community formed by microorganisms producing extracellular polymers and clustering in the matrix (...)

Epidemiology of Culture-confirmed Candidemia Among Hospitalized Children in South Africa, 2012-2017.

We aimed to describe the epidemiology of candidemia among children in South Africa. We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates. Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004). Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.

Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience.

This study aimed to investigate the epidemiology of candidemia and evaluate the impact of adherence to the candidemia guideline defined by the European Confederation of Medical Mycology Quality of Clinical Candidemia Management (EQUAL) Candida score. Adult candidemia patients ≥ 19 years diagnosed at a tertiary care hospital in the Republic of Korea from 2013 to 2018 were enrolled (period 1 2013–2015, period 2 2016–2018). There was a total of 223 patients. The annual incidence of candidemia increased from 0.43 to 1.33 cases per 1000 admissions between 2013 and 2018, p < 0.001. A significant increase of fluconazole-resistant C. parapsilosis candidemia was noted in period 2 (35.3%) when compared to period 1 (0.0%), p = 0.020. The 30-day mortality rate was not different between period 1 and 2 (43.5% vs. 48.1%, p = 0.527). Multivariate analysis revealed that a Charlson comorbidity index score ≥ 4, neutropenia, duration of hospital stay ≥ 21 days before candidemia diagnosis, septic shock, mycological failure, and EQUAL Candida score < 15 were significantly associated with 30-day mortality. An increase in the incidence of candidemia and fluconazole resistance in the non-albicans Candida species over time was observed. Disease severity, comorbidities, and lower adherence to the candidemia guideline were associated with mortality.

Epidemiology and risk factors of candidemia due to Candida parapsilosis in an intensive care unit.

ABSTRACTWe analyzed the clinical features and risk factors of candidemia due to C. parapsilosis (n=104) in the intensive care unit of a tertiary hospital over six years. This was a monocentric, retrospective study of candidemia, conducted from January 2013 to March 2019. Epidemiological characteristics, clinical features, invasive procedures, laboratory data and outcomes of 267 patients with candidemia were analyzed to determine risk factors of candidemia due to C. parapsilosis. Sixty-three cases of C. albicans and 204 cases of non-C. albicans Candida (NCAC) species were included, the latter was composed of 104 cases of C. parapsilosis and 100 cases of non-C. albicans species (46 cases of C. tropicalis, 22 cases of C. glabrata, 23 cases of C. guilliermondii, 5 cases of C. krusei and 4 cases of C. lusitaniae), suggesting that C. parapsilosis was the predominant Candida species isolated from cases of candidemia. A binary multivariate logistic regression analysis showed that APACHE II scores, central venous catheterization and the use of broad-spectrum antibiotics were closely related to C. parapsilosis candidemia, with OR values of 1.159, 3.913 and 2.217, respectively. In conclusion, we found that C. parapsilosis was the main pathogen among the NCAC candidemia in the ICU patients. APACHE II scores, central venous catheterization and the use of broad-spectrum antibiotics were independent risk factors for the occurrence of C. parapsilosis candidemia, which may provide data to support the early introduction of anti-fungal 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.

Distribution of candidemia in Malaysian tertiary care hospital revealed predominance of Candida parapsilosis.

Candida parapsilosis is an important pathogen of healthcare-associated bloodstream infections (BSI) causing high mortality and morbidity in immunocompromised patients in addition to other Candida species including C. albicans, C. tropicalis, C. glabrata, and C. krusei. Knowledge on recent local species distribution and trend is essential. An increase in the proportion of C. parapsilosis candidemia has been recently observed as a result of many risk factors. The distribution of candidemia has been changing in the last three decades. To determine the proportion of different Candida species causing candidemia in a tertiary-care hospital during January 2001 - December 2018, a retrospective study performed in a 853-bedded tertiary-care hospital in north-eastern Malaysia. All cases of candidemia from January-2001 to December-2018 were included, and the review was performed based on patients' medical records and laboratory database. The frequency of different Candida species was determined. This study showed that out of 1175 patients with candidemia, C. parapsilosis was the most common species contributing to 29.2% (343/1175) of candidemia, followed by C. albicans 20.1% (236/1175), C. tropicalis 18.7% (220/1175), C. glabrata 6.0% (71/1175), C. guilliermondii 3.7% (43/1175), C. rugosa 1.9% (22/1175), C. famata 1.7% (20/1175), C. krusei 1.4% (16/1175), C. dubliniensis 0.8% (9/1175), C. lusitaniae 0.7% (8/1175), C. lipolytica 0.3% (4/1175), C. pelliculosa 0.3% (4/1175), C. haemulonii, C. kefyr, C. utilis and C. inconspicua (1/1175 each). In addition, 14.9% (175/1175) belonged to Candida spp. which were not identified to species level. In conclusion, a different scenario for the proportion of Candida species with C. parapsilosis predominates over C. albicans as a nosocomial pathogen leading to candidemia has been shown in this study.

Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study

BackgroundThe aim of this study was to evaluate the possible risk factors for mortality in adult patients with candidemia by investigating the causative agents, underlying conditions and predisposing factors. Material and methodsThe data including causative Candida species, predisposing factors, and underlying conditions of candidemia patients between the years 2015–2017 were collected and the impact of these factors on mortality was evaluated. Patients were divided into two groups as died (died patients within 30 days of the onset of candidemia) and survived and risk factors were evaluated for each group. ResultsWe found 163 adult candidemia cases during the study period. Overall 30-day mortality was 40.5%. Candida parapsilosis was the most frequent causative agent (49.1%). C. parapsilosis candidemia was more common in the survived group compared with the died group (n: 49 (61.3%) vs. n: 31 (38.8%), P=0.888). Mortality rates were significantly higher in patients with dialysis (n: 27 (69.2%) vs. n: 12 (30.8%), P<0.00) and concurrent bacteremia (n: 20 (57.1%) vs. n: 15 (42.9%), P=0.024). Survival rates were significantly higher in patients with follow-up blood cultures (n: 75 (65.8%) vs. n: 39 (34.2%), P=0.013). The most important source of candidemia was catheter (49.7%), and C. parapsilosis was the most common causative agent (58%). The catheter was removed in 96.3% of these patients and the mortality rate was 38.5%. All of the patients received antifungal therapy and there was no significant difference between the effects of antifungals on mortality (n: 65 (39.9%) vs. 98 (60.1%), P=0.607). ConclusionsDialysis and concurrent bacteremia are strong predictors of mortality in 30 days within patients with candidemia, whereas follow-up blood cultures have a protective role with lower mortality rates. In our study, the most important source of candidemia was catheter, and C. parapsilosis was the most common causative agent. The catheter was removed in almost all patients and the mortality rate was almost one third among these patients.

The high rate of Candida parapsilosis candidemia among non-burn patients with polytrauma in the surgical intensive care units of a university hospital

Aim: Candidemia is a life-threatening infection that has been reported to be associated with poorer outcomes in trauma patients. The present study aimed to investigate the epidemiology of candidemia in non-burn patients with polytrauma.Material and Methods: We conducted a retrospective, single-center, observational study of polytrauma patients with candidemia admitted to the surgical intensive care units of a university hospital in Turkey between 2013 and 2017 on. Results: The incidence of candidemia was 127 episodes per 1000 intensive care unit admissions in polytrauma patients. Non-albicans Candida species accounted for 75.5% of all candidemia episodes. C. parapsilosis (51.05%) was the predominant species, followed by C. albicans (24.52%) and C. tropicalis (12.21%). The highest crude mortality rate (72%) was observed in patients with C. parapsilosis candidemia. In multivariate analyses, who had undergone prior gastrointestinal surgery were 7.1 times more likely to have C. parapsilosis candidemia than those with other strains.Conclusion: Our study, remarkable, demonstrated a high incidence of Candidemia had in polytrauma patients, and non-albicans Candida species were the most frequently isolated candida species. According to our study findings, a prior history of gastrointestinal surgery may help predict C. parapsilosis, as the causative agent of candidemia in polytrauma patients. However, since our study was observational and limited to such a small number of patients, the results obtained should be applied with caution.

1698. Epidemiology and Antifungal Susceptibility of Candidemia Among Adult Patients at a Tertiary Care Hospital in South Korea During an 8-Year Period

BackgroundCandidemia continues to contribute to significant morbidity and mortality in the hospital. This study aimed to evaluate the epidemiology and antifungal susceptibility at a tertiary care hospital in South Korea during an 8-year period.MethodsAdult patients ≥19 years with candidemia at a tertiary care hospital in South Korea from 2006 to 2018 were reviewed, and cases of candidemia with antifungal susceptibility data were included for the analysis.ResultsThere were 270 cases of candidemia with fluconazole susceptibility data from 2011 to 2018. Overall, fluconazole resistance rate of candidemia was 8.5%. Between period 1 (2011–2015) and period 2 (2016–2018), fluconazole resistance rate was significantly higher in the period 2 (14.3%) than in the period 1 (0.9%), P < 0.001. Among candidemia caused by different Candida spp., a significant increase of fluconazole-resistant C. parapsilosis candidemia was noted in the period 2 (12 out of 34 cases; 35.3%) when compared with the period 1 (0 out of 17 cases; 0.0%), P = 0.004. Although there was a trend of higher fluconazole resistance rate for candidemia caused by C. albicans (9.1% vs. 1.8%), C. tropicalis (2.7% vs. 0.0%), and C. glabrata (11.1% vs. 0.0%) in the period 2 than in the period 1, no statistical significance was observed. Echinocandin (caspofungin and micafungin) susceptibility data were available for 211 cases of candidemia from 2013 to 2018. There were no cases of caspofungin-resistant candidemia except for 2 cases of C. utilis candidemia. However, there were 9 cases of micafungin-resistant candidemia (1 case of C. tropicalis candidemia out of 51 cases [2.0%], 6 cases of C. glabrata candidemia out of 18 cases [33.3%], and 2 cases of C. utilis candidemia out of 2 cases [100.0%]). Micafungin-resistant C. tropicalis and C. glabrata candidemia cases were susceptible to caspofungin.ConclusionA significant increase of fluconazole-resistant candidemia in recent years was noted, particularly among C. parapsilosis candidemia cases. Echinocandin resistance among candidemia cases is rare. However, close monitoring needs to be considered for the possible emergence of differential echinocandin resistance.Disclosures All authors: No reported disclosures.

BIOF-HILO Assay: A New MALDI-TOF Mass Spectrometry Based Method for Discriminating Between High- and Low-Biofilm-Producing Candida parapsilosis Isolates.

Candida parapsilosis is the most frequent cause of catheter-related candidemia among non-Candida albicans species. This may be related to intrinsic capabilities as adhering and forming a biofilm on abiotic surfaces such as on medical devices. As previously demonstrated, patients infected with high biofilm-producing C. parapsilosis isolates had a greater mortality risk compared to patients infected with low biofilm-producing C. parapsilosis isolates. We developed the BIOF–HILO assay, a MALDI–TOF mass spectrometry (MS)-based assay, which compares mass spectra obtained from attached and suspended isolate cells during the early (i.e., 3-h) adhesion phase of in vitro biofilm formation. The composite correlation index (CCI) analysis was used to discriminate between mass spectra differences of the two cell types, classifying all 50 C. parapsilosis clinical isolates, included in the study, after only 3-h of testing, in high or low biofilm producers. All high (n = 25) or low (n = 25) biofilm producers had, according to CCI mass spectra comparison values, higher or lower than one CCI ratios, which were obtained by dividing the CCIsuspended cells by the CCIattached cells. In conclusion, the BIOF–HILO assay allows a rapid categorization of C. parapsilosis clinical isolates in high or low biofilm producers. This information, if timely provided to physicians, may improve treatment outcomes in patients with C. parapsilosis candidemia.

Mortality and risk factor analysis for Candida blood stream infection: A multicenter study.

Candida blood stream infection (candidemia) is severe systemic infection mainly develops after intensive medical cares. The mortality of candidemia is affected by the underlying conditions, causative agents and the initial management. We retrospectively analyzed mortality-related risk factors in cases of candidemia between April 2011 and March 2016 in five regional hospitals in Japan. We conducted bivariate and multivariate analysis of factors including causative Candida species, patients' predisposing conditions, and treatment strategies, such as empirically selected antifungal drug and time to appropriate antifungal treatment, to elucidate their effects on 30-day mortality. The study enrolled 289 cases of candidemia in adults. Overall 30-day mortality was 27.7%. Forty-nine cases (17.0%) were community-acquired. Bivariate analysis found advanced age, high Sequential Organ Failure Assessment (SOFA) score, and prior antibiotics use as risk factors for high mortality; however community-acquired candidemia, C.parapsilosis candidemia, obtaining follow-up blood culture, and empiric treatment with fluconazole were associated with low mortality. Logistic regression revealed age ≥65 years (adjusted odds ratio, 2.13) and sequential organ failure assessment (SOFA) score ≥6 (6.30) as risk factors for 30-day mortality. In contrast, obtaining follow-up blood culture (0.38) and empiric treatment with fluconazole (0.32) were found to be protective factors. The cases with candidemia in associated with advanced age and poor general health conditions should be closely monitored. Obtaining follow-up blood culture contributed to an improved prognosis.

Increase in Candida Parapsilosis Candidemia in Cancer Patients.

This study aimed to identify the risk factors of candidemia and asses possible clinically significant differences between Candida parapsilosis and other Candida species in a Chinese tertiary cancer center over six years. A total of 323 cancer patients were enrolled and analyzed from 2012 to 2018. Among the isolates, the species most frequently isolated was C. parapsilosis (37.15%, 120/323), and C. albicans only accounted for 34.37%. Based on statistical analysis, when candidemia patients who had C. parapsilosis were compared with other Candida spp., the following factors were found to be significantly associated with C. parapsilosis fungemia: parenteral nutrition (p < 0.001), neutropenia (p < 0.001), receipt of chemotherapy (p = 0.002), and previous antifungal use (p < 0.001). Parenteral nutrition was a factor that independently predicted C. parapsilosis candidemia (OR, 0.183; 95% CI, 0.098–0.340; p < 0.001).In short, C. parapsilosis as the leading non-albicans Candida spp. isolates in candidemia are posing a major threat for cancer patients. The study highlights the urgent need to evaluate the possibility of development of C. parapsilosis candidemia in cancer patients exposed to these risk factors effective and prevention strategies against this causative agent transmitted through nosocomial route should be implemented.