Positive Candida Culture Research Articles

Epidemiology of Vulvovaginal Candidiasis in Greece: A 2-Year Single-Centre Study.

The epidemiology of vulvovaginal candidiasis (VVC) in Greece remains poorly reported and outdated. We therefore conducted a 2-year retrospective survey to assess the epidemiological aspects of the infection among symptomatic Greek patients. High vaginal swab samples were collected from adult women with clinically suspected VVC attending a private diagnostic laboratory in Athens. VVC was confirmed through microscopic examination of a wet mount preparation revealing yeasts and Candida-positive culture. Species were identified by MALDI-ToF MS, and invitro susceptibility was determined according to the EUCAST-E.Def 7.4. Predisposing host factors were associated with the occurrence of the infection and isolated Candida spp. using Fisher's exact test, and epidemiological changes over time were analysed with the χ2 test for trend. Among 1300 women screened, 283 VVC episodes were recorded among 233 (18%) patients, whereof 11 (5%) had recurrent VVC (RVVC) and 19 (8%) had mixed Candida infections. Coinfection with other pathogens and recent prior use of antifungals were associated with RVVC. Candida albicans was the most prevalent pathogen (50%), followed by Candida parapsilosis sensu stricto (SS) (35%), Nakaseomyces glabratus (former Candida glabrata) (10%), Pichia kudriavzevii (former Candida krusei) (3%), Candida orthopsilosis (1.5%) and Clavispora lusitaniae (former Candida lusitaniae) (0.5%). Regarding the RVVC cases, 54% were attributed to C. albicans, 37% to N. glabratus and 9% to C. parapsilosis SS. Resistance to fluconazole was found in 4% of C. albicans and 23% of N. glabratus strains with cross-resistance to other azoles. Fluconazole-resistant isolates were recovered from 5 of 11 RVVC patients, whereof 4 of 5 had previous exposure to azoles. During the study period, an increase in N. glabratus VVC and fluconazole resistance was noted. VVC is common in our region, with C. albicans as the predominant species, followed by C. parapsilosis SS and N. glabratus. Fluconazole resistance is low in C. albicans but high in N. glabratus, emphasising the need for targeted antifungal strategies.

Fluconazole for Preventing Radiation-Induced Oral Mucositis: A Randomized Controlled Trial.

This study evaluated the efficacy of fluconazole prophylaxis in reducing radiation-induced oral mucositis (RIOM) and Candida carriage in head and neck cancer (HNC) patients undergoing concurrent chemoradiotherapy (CCRT). A prospective, double-blinded, randomized controlled trial was conducted with 78 HNC patients receiving either fluconazole (100 mg daily) or placebo during CCRT. The primary outcome was the incidence of grade 2 or higher RIOM. Secondary outcomes included positive Candida cultures and colony-forming units (CFUs). Mixed-effects ordinal logistic regression and logistic regression were used for analysis. Fluconazole significantly reduced the incidence of grade 2 or higher RIOM at week 7 (p = 0.039), positive Candida carriage at week 4 (p = 0.024) and week 7 (p = 0.029), and median CFUs at week 7 (p = 0.050). Fluconazole significantly reduces RIOM severity and Candida colonization in HNC patients undergoing CCRT, suggesting its efficacy as a prophylactic treatment.

Species distribution and antifungal susceptibility patterns of Candida involvement in pediatric solid organ transplant recipients: A cross-sectional study from a single transplant center

The epidemiology and resistance patterns of Candida infections in pediatric kidney/liver recipients has not been well characterized, recently. In this study, all patients ≤ 18 years old who underwent liver/kidney transplant surgery between September 2021 and 2022 were included. Species identification of isolates recovered from clinical specimens was performed by DNA-sequencing method following amplification of the ITS1–5.8S–ITS2 regions. Antifungal susceptibility patterns of isolates were performed using the micro broth dilution method documented by Clinical & Laboratory Standards Institute (CLSI) guidelines. Of the 117 pediatric recipients enrolled, 16 recipients (13.7 %) had at least one positive Candida culture. Candidemia was detected in 5/89 (5.6 %) of liver and 1/28 (3.6 %) of kidney transplant recipients. Invasive candidiasis was observed in 6/89 (6.7 %) of liver and 2/28 (7.1 %) of kidney transplant recipients. The predominant species was Candida (C.) albicans recovered from 12 of 16 recipients (75 %). In addition to the Pichia kudriavzevii species with inherent resistance to fluconazole, one of C. albicans isolates and one C. tropicalis isolate were also identified as fluconazole-resistant (3/29:10.3 %). Moreover, our findings revealed 13.8 % and 6.8 % resistance to itraconazole and voriconazole, respectively. All Candida spp. were susceptible to caspofungin. Collectively, this study provides valuable insights into the epidemiology and resistance patterns of Candida infections in pediatric kidney and liver recipients. The study also highlights the emergence of fluconazole-resistant strains, which has significant implications for antifungal stewardship efforts in pediatric transplant populations.

Infective Endocarditis in the Young, Risk Profile, Patient Demographics and Hospital Outcome during Hospital Stay. Registry among Ain Shams University Hospitals

Abstract Background Infective endocarditis (IEC) is a serious and potentially life-threatening condition if left untreated. Objective To identify demographics, risk profile and hospital outcome during hospital stay of young patients with infective endocarditis admitted to Ain Shams University Hospitals. Patients and Methods We developed a registry to describe patient demographics, risk factors, clinical features, and hospital outcomes for all cases of infective endocarditis diagnosed using modified Duke's criteria referred to Ain Shams University in Egypt over a six-month period. Results We collected 72 confirmed cases of infective endocarditis that presented to Ain Shams University hospitals over a six-month period (from August 2023 to January 2024). We observed that the mean age was 35 years [(87.5 %) males and (12.5%) females]. Among them, (70.8%) were smokers, (68.1%) were IV drug users. Three main substances that were used were opioids, heroin and cocaine. Only two patients were diabetic, five were hypertensive and one was diagnosed with chronic kidney disease before admission. The most common predisposing factors were IV drug use in (65%), rheumatic heart disease in (22%), followed by patients that had underwent an invasive procedure (16.7%), those who had a recent dental procedure (16.7%), and lastly patients born with congenital heart defects (11.1%). Positive blood cultures were encountered in (95.8%) of patients, with the most common organism being Staphylococcus Aureus in (52.8%) of cases. Three patients had positive fungal cultures for Candida. Most common antibiotics that were used were vancomycin (47.2%), gentamycin (50%), line (27.8%), ampicillin and sulbactam (18.1%), teicoplanin (8%). The three patients that had positive fungal cultures for Candida showed sensitivity for fluconazole. Concerning our echocardiographic findings, we noticed that at least one vegetation was present in every patient. Most patients had only one vegetation (72.2%), the rest had two vegetations. 62 patients (83.3%) had vegetations over 10mm. Native valve affection was present in 63 patients (87.5%) while prosthetic valve affection was in 4 patients representing (5.6%) of patients, VSD related vegetation was in (4.2%) and CIED vegetations represented (2.8%) of all studied patients. Two patients experienced valvular complications, one patient had a mitral valve perforation and the other had a paravalvular leak after recent valve replacement. Pericardial effusion was present in (8.3%) of the studied patients, it was mild in (4.2%), moderate in (2.8%) and severe in (1.4%) of cases All patients had elevated CRP and ESR on admission. Regarding viral markers, (48.6%) were negative for HBV, HCV and HIV. However, (40.3%) had positive viral markers from which 29 were HCV only positive, 2 were HBV only positive, 2 were HIV only positive and 4 were positive for both HBV and HCV. Concerning the outcome of the patients, (81.9%) of patients continued their course of treatment and discharged while in-hospital mortality represented (18.1%). Conclusion Our study revealed that the first cause of infective endocarditis in the studied young population was IV addiction. Also, it revealed that the most common organism was staphylococcus aures.

Bridging Echinocandin With Azole Antifungal Therapy on Prevention of Invasive Candidiasis Post-Lung Transplantation.

Invasive candidiasis (IC) is a significant factor for lung transplant recipient (LTR) mortality, especially in the immediate postoperative phase. Receipt of antifungal prophylaxis has demonstrated lower all-cause mortality. This was a single-center, retrospective cohort study of LTRs between August 2017 and August 2020. Included patients were adult LTRs with positive Candida cultures preoperatively (donor or recipient) or within 6 weeks postoperatively. Patients were divided into 2 cohorts-bridged and unbridged. The bridged cohort received micafungin in the postoperative period until therapeutic azole concentrations were achieved or up to 2 weeks, whichever was sooner. The primary outcome was a composite of proven or probable invasive candidiasis. A total of 117 patients were included in the study, with 68 in the unbridged cohort and 49 in the bridged cohort. There were more cases of IC in the bridged cohort than in the unbridged cohort (P = .011). In combination with an azole antifungal, micafungin did not prevent IC in postoperative LTRs with cultures positive for Candida species in this cohort. Larger prospective studies are needed to determine the ideal combination and duration of antifungal prophylaxis.

Time-to-Positivity for Candida in Bloodstream Infections: Prognostic Implications for Mortality.

Background Candida-associated catheter-related bloodstream infections (CRBSIs) present a significant challenge in clinical settings, particularly among patients with central venous catheters (CVCs). Time-to-positivity (TTP) of blood cultures, an indicator of fungal load, may provide insights into infection prognosis and severity. This study evaluates the role of TTP in Candida-associated bloodstream infections and its impact on patient outcomes. Materials and methods This cross-sectional observational study, conducted from July 2023 to June 2024 at Saveetha Medical College, involved collecting blood cultures from intensive care unit (ICU) patients with suspected candidemia. Blood cultures were processed using the BacT/ALERT 3D system (bioMérieux, Marcy l'Étoile, France), with TTP recorded for each Candida-positive culture. Species identification was performed using MALDI-TOF MS (Bruker Daltonics, Germany). Species-specific 30-day mortality was analyzed to assess the impact of TTP on survival. Results Of 7447 blood cultures from ICU patients, 2349 were positive, with a 2.42% prevalence of Candida sp. Among 57 candidemia patients, the median TTP for deceased patients was 24 hours, compared to 25 hours for survivors (p=0.001). C. auris exhibited the highest mortality rate (56.25%) with a median TTP of 16.5 hours, whereas C. albicans had no associated mortality and a median TTP of 28.5 hours. Shorter TTP was consistently associated with higher mortality across Candida species. Conclusion This study highlights the prognostic value of TTP in Candida-associated bloodstream infections, with shorter TTP correlating with higher mortality. The findings underscore the need for rapid diagnosis and aggressive treatment, particularly for high-risk species like C. auris and C. glabrata. Further research is needed to refine the clinical application of TTP and develop targeted treatment strategies.

Treatment Outcomes Among Patients With a Positive Candida Culture Close to Randomization Receiving Rezafungin or Caspofungin in the ReSTORE Study.

Rezafungin, a novel, once-weekly echinocandin for the treatment of candidemia and/or invasive candidiasis (IC) was noninferior to caspofungin for day 30 all-cause mortality (ACM) and day 14 global cure in the phase 3 ReSTORE trial (NCT03667690). We conducted preplanned subgroup analyses for patients with a positive culture close to randomization in ReSTORE. ReSTORE was a multicenter, double-blind, double-dummy, randomized trial in patients aged ≥18 years with candidemia and/or IC treated with once-weekly intravenous rezafungin (400 mg/200 mg) or once-daily intravenous caspofungin (70 mg/50 mg). This analysis comprised patients with a positive blood culture drawn between 12 hours before and 72 hours after randomization or a positive culture from another normally sterile site sampled between 48 hours before and 72 hours after randomization. Efficacy endpoints included day 30 ACM, day 14 global cure rate, and day 5 and 14 mycological response. Adverse events were evaluated. This analysis included 38 patients randomized to rezafungin and 46 to caspofungin. In the rezafungin and caspofungin groups, respectively, day 30 ACM was 26.3% and 21.7% (between-group difference [95% confidence interval], 4.6% [-13.7%, 23.5%]), day 14 global response was 55.3% and 50.0% (between-group difference, 5.3% [-16.1%, 26.0%]), and day 5 mycological eradication was 71.1% and 50.0% (between-group difference, 21.1% [-0.2%, 40.2%]). Safety was comparable between treatments. These findings support the efficacy and safety of rezafungin compared with caspofungin for the treatment of candidemia and/or IC in patients with a positive culture close to randomization, with potential early treatment benefits for rezafungin.

Risk factors for the development of candidemia in patients with positive urine surveillance culture for Candida spp.

The objective of the study was to characterize candiduria in patients admitted to a tertiary hospital and establish the risk factors associated with the development of candidemia. To this end, a laboratory and clinical surveillance study was carried out with samples of Candida spp. previously isolated from urine surveillance cultures of patients admitted to the Intensive Care Unit, during the period from 2019 to 2020. It was demonstrated that the incidence of candidemia in patients with positive urine cultures for Candida spp. it was 17.7 per 1000 admissions and 80% of patients who developed candidemia died. The chance of developing candidemia was eight times greater in patients who had diseases of the digestive system that caused hospitalization and 26 times greater in those who had Coronary Artery Disease (CAD), compared to patients who did not have the comorbidity. We concluded that the possibility of developing candidemia from candiduria is 4.5%, however, the onset of candidemia, regardless of the source, worsens the patient's prognosis.

Guideline Adherence and Outcomes of Patients with Candidemia in Brazil.

Candidemia is a significant cause of mortality among hospitalized patients, both worldwide and in Brazil. Prompt and appropriate treatment are essential to mitigate mortality, and clinical practice guidelines aim to optimize patient care based on the best scientific evidence. This study aims to examine the management of candidemia, assessing adherence to the guidelines of the Brazilian Society of Infectious Diseases in a single center located at São Paulo, Brazil. All adult patients hospitalized from 2016 to 2018 who presented one positive blood culture for Candida spp. were included. Electronic medical records were retrospectively reviewed to collect information relevant to the treatment for candidemia, in order to assess the adherence to the Brazilian guideline for the management of candidemia in relation to nine defined outcomes, and we correlated those findings with 30-day mortality by using uni- and multivariate analyses. A total of 115 patients were included; 68 patients (59.1%) were male, with a mean age of 55 years. C. albicans, C. tropicalis and C. glabrata were the most prevalent species. In total, 80 patients (69.5%) received antifungal treatment. The adherence to Brazilian guideline recommendations was determined as described in the following: initial treatment with echinocandin in 48 (60%); step-down to fluconazole in 21 (26.2%); collection of first control blood culture in 43 (58.9%); collection of second control blood culture, if the first one had been positive, in 14 (73.6%); treatment for 14 days after the first negative blood culture in 53 (65.4%); central venous catheter (CVC) removal in 66 (82.5%); CVC removal if the first control blood culture had been positive in 17 (89.4%); performance of a transthoracic echocardiogram in 51 (63.7%) and performance of a fundoscopy in 59 (73.7%). Univariate analysis showed that CVC removal and initial echinocandin therapy were more prevalent in the surviving group, but with no statistically significant difference. On the other hand, step-down to fluconazole demonstrated higher survival rate in the multivariate analysis OR 0.15 (95% CI 0.03-0.8); p = 0.02. The analysis of these nine recommendations demonstrates that it is necessary to improve adherence to specific recommendations and also disseminate strategies of the initial use of echinocandin as the drug of choice and addressing length of treatment and follow-up and complementary exams. Our study provides reassurance that the step-down to fluconazole is safe and may be recommended, if the preexisting conditions are present.

Prediction of candidemia in pediatric patients based on central venous catheter: Real world evidence to guide antifungal empirical prescription

Background: Candida is one of the main etiological agents of bloodstream nosocomial infections, and is associated with high morbidity/mortality in children. High use of empirical antifungals incurs in higher health care costs and concerns on emergent resistant Candida spp. Therefore, a prediction model should optimize prescribing empirical antifungals in pediatrics. Objective: Based on real-world evidence data, we aimed at assessing how accurate is a regression model for predicting central venous catheter (CVC) candidemia in pediatric patients. We also explored how this prediction model might be useful for prescribing antifungals empirically. Methods: A case-control study was conducted based on 144 patients with positive and negative blood cultures for Candida spp.. A model for predicting Candida spp. was developed through univariate and multivariate analyses (logistic regression). Data were reported as odds ratio (OR) and p-value less than 0.05 was considered statistically significant. Results: Candidemia was predicted by the presence of CVC (OR 2.561, p=0.0042). For this model, an area under the curve (AUC) of 0.550 (p=0.314) was estimated, representing the Receiver Operating Characteristic curve of the present study, with a sensitivity of 86% and a specificity of 24%. Conclusion: Our study demonstrated that CVC is a fragile predictor for candidemia, however, its clinical significance and low specificity obtained in the ROC curve suggests that other covariates rather than those investigated should be considered to assess its impact on a prediction model for pediatric patients.

The Prevalence of Non-albicans Candida and Candida Mixed-species in Vulvovaginal Candidiasis in Northeast Iran

Background: Vulvovaginal candidiasis (VVC) is a prevalent infectious disease that affects the majority of women. While Candida albicans is the most common cause of VVC, the prevalence of non-albicans species is increasing, and mixed infections have made treatment more challenging. This study aimed to identify Candida species and detect mixed infections in women with VVC in a tropical region of northeastern Iran, employing the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Methods: In the prospective study, a total of 270 specimens of vaginal discharge were collected using sterile swabs from patients suspected of having VVC. After extracting DNA from Candida colonies, the genome was amplified using PCR with specific primers. Species identification was conducted through PCR-RFLP analysis of the ribosomal DNA internal transcribed spacer (ITS) regions, using the MspI restriction enzyme. Results: Out of the 270 specimens suspected of VVC, 167 tested positive for Candida cultures. Among these positive Candida cultures, Candida species were identified in 150 specimens, with 44 (29.3%) showing evidence of mixed Candida infections. The species of Candida in 17 specimens were not identified. Out of the 190 identified Candida isolates included, the distribution was as follows: 85 (44.8%) C. albicans, 39 (20.5%) C. glabrata, 28 (14.7%) C. guilliermondii, 11 (5.8%) C. kefyr, 11 (5.8%) C. parapsilosis, 8 (4.2%) C. tropicalis, and 8 (4.2%) C. krusei. The mixed Candida species combinations observed were as follows: C. albicans/C. guilliermondii 26 (65%), C. albicans/C. kefyr 4 (10%), C. parapsilosis/C. glabrata 4 (10%), C. parapsilosis/C. tropicalis 4 (10%), C. krusei/C. tropicalis 2 (5%), C. albicans/C. parapsilosis 1 (2.5%), C. albicans/C. krusei 1 (2.5%), C. glabrata/C. guilliermondii 1 (2.5%), and C. kefyr/C. tropicalis 1 (2.5%). Conclusions: In women with VVC in the tropical region of northeastern Iran, the prevalence of clinical non-albicans species is higher than that of C. albicans. Furthermore, there is a notable high prevalence of clinical specimens containing mixed Candida infections.

Role of source control in critically ill candidemic patients: a multicenter retrospective study

PurposeCandidemia is associated with high mortality especially in critically ill patients. Our aim was to identify predictors of mortality among critically ill patients with candidemia with a focus on early interventions that can improve prognosis.MethodsMulticenter retrospective study.SettingThis retrospective study was conducted in Intensive Care Units from three European university hospitals from 2015 to 2021. Adult patients with at least one positive blood culture for Candida spp. were included. Patients who did not require source control were excluded. Primary outcome was 14-day mortality.ResultsA total of 409 episodes of candidemia were included. Most candidemias were catheter related (173; 41%), followed by unknown origin (170; 40%). Septic shock developed in 43% episodes. Overall, 14-day mortality rate was 29%. In Cox proportional hazards regression model, septic shock (P 0.001; HR 2.20, CI 1.38–3.50), SOFA score ≥ 10 points (P 0.008; HR 1.83, CI 1.18–2.86), and prior SARS-CoV-2 infection (P 0.003; HR 1.87, CI 1.23–2.85) were associated with 14-day mortality, while combined early appropriate antifungal treatment and source control (P < 0.001; HR 0.15, CI 0.08–0.28), and early source control without appropriate antifungal treatment (P < 0.001; HR 0.23, CI 0.12–0.47) were associated with better survival compared to those without neither early appropriate antifungal treatment nor source control.ConclusionEarly source control was associated with better outcome among candidemic critically ill patients.

Burden of Candida-related vascular graft infection: a nested-case control study.

We aimed to assess risk factors of candida-related Vascular Graft Infections (VGIs). We did a case-control study (1:4) matched by age and year of infection, nested in a cohort of patient with a history of VGIs. Cases were defined by a positive culture for Candida spp. in biological samples and controls were defined by a positive culture for bacterial strains only in biological samples. Risk factors for Candida-related VGIs were investigated using multivariate logistic regression. Mortality were compared using survival analysis. 16 Candida-related VGIs were matched to 64 bacterial-related VGIs. The two groups were comparable regarding medical history and clinical presentation. Candida-related VGIs were associated with bacterial strains in 88% (14/16). Gas/fluid-containing collection on abdominal CT scan and the presence of an aortic endoprosthesis were risk factors for Candida spp.-related VGIs [RRa 10.43 [1.81-60.21] p = 0.009 RRa and 6.46 [1.17-35.73] p = 0.03, respectively]. Candida-related VGIs were associated with a higher mortality when compared to bacterial-related VGIs (p = 0.002). Candida-related VGIs are severe. Early markers of Candida spp. infection are needed to improve their outcome. The suspicion of aortic endoprosthesis infection may necessitate probabilistic treatment with antifungal agents.

Candida Bloodstream Infection and Antifungal Susceptibility Over Three Years in a Single Center from Medinah, Saudi Arabia

In the healthcare setting, Candida bloodstream infections significantly increase morbidity and mortality. There is little proof that invasive infections in Saudi Arabia are brought on by Candida spp. To identify Candida species that cause bloodstream infections and ascertain the clinical outcome and risk factors for mortality in a Saudi Arabian tertiary hospital. This retrospective analysis covered all instances in which patients hospitalized to Ohud hospital, a tertiary care facility in Madinah, Saudi Arabia, between January 2019 and December 2021, had positive blood cultures for Candida. Anaerobic and aerobic Bactec bottles were inoculated with blood samples and then incubated at 35°C for five days. Identification-YST card kits from VITEK II (BioMerieux, France) for yeast and yeast-like organisms. Testing for antifungal susceptibility was done using AST YS07. A total of 78 patients (71% men, 29% women) were found to have candidemia. Candida albicans (51.3%), Candida parapsilosis (16.7%), and Candida tropicalis (16.7%) were the three Candida spp. that were most frequently isolated. Those with Saudi (51%; P = 0.500), leukopenia (40%; P = 0.001), neutrophilia (92%; P = 0.638), and thrombocytopenia (42%; P = 0.374) had a higher incidence of candidemia. Fluconazole sensitivity in non-albicans Candida species was 39.5%. Nonetheless, caspofungin was effective against all species. This study discovered an epidemiological shift toward more non-albicans Candida spp. in Saudi Arabia as well as a changing pattern in the Candida spp. causing bloodstream infections.

METABOLIC PARAMETERS IN TYPE 2 DIABETIC PATIENTS WITH POSITIVE CANDIDA CULTURES

The gut microbiota plays an important role in host metabolism, immunity, digestibility and even behaviour. Candida spec. is common resident of the gastrointestinal tract and integral part of the microbiota. The aim of the study was to evaluate if positive Candida cultures in the stool influence metabolic parameters in type 2DM patients. 46 patients with type 2 DM and oral antidiabetic treatment, were divided into a study group (S=18 patients with positive Candida sp. cultures in stool) and the control group (C= remaining 28 patients). Besides medical history and clinical examination, all patients were tested for coproculture, fasting glycaemia (FPG), HbA1C, total cholesterol (CL) triglycerides (TG), high- density lipoproteins (HDL) and low- density lipoproteins (LDL). Study group patients had a significantly higher BMI (31.41 ± 5.29 vs. 25.18 ± 3.58; p&lt;0.001); HbA1C (9.8 % ± 1.74 vs 6.9% ± 1.89; p&lt;0.05) as well as FPG (10.87 ± 1.35 vs 7.47 ± 1.03; p&lt;0.01), compared to the control group. Even though the study group patients had higher TG, CL, LDL and HDL, compared to the control group, there was no statistical significance verified. Uncontrolled glucoregulation is one of the host condition which favours candida colonization and subsequent infection. This may be related to the decrease in commensal bacteria, probably as the result of yeast-bacterial competition. On the other hand, we have to keep in mindthat a significantly increased number of Candida colonies can affect the rate of digestion and absorption of carbohydrates and consequently increase the level of glycaemia in patients with diabetes.

471. Comparison of Outcomes for Obese and Non-Obese Patients Receiving Micafungin 100 mg Daily for Candidemia

Abstract Background Echinocandins, such as micafungin, are first-line agents for the treatment of candidemia. Researchers have questioned the adequacy of the standard 100 mg dose for all patients, as certain characteristics such as obesity can significantly alter the pharmacokinetics of this agent. Prior data have shown obese patients may be less likely to achieve the pharmacodynamic targets shown to be associated with clinical success. The purpose of this study is to compare clinical outcomes for obese and non-obese patients receiving standard dosing of micafungin. Methods This is a multi-center, retrospective study conducted at two large academic hospitals. All adults admitted with a positive blood culture for Candida spp. between January 1st 2017 and December 31st 2021 were reviewed for inclusion. Patients who received &amp;gt; 1 dose of micafungin were designated as either obese (BMI ≥ 30 kg/m2) or non-obese (BMI &amp;lt; 30 kg/m2). Patients who received combination antifungal therapy or had subsequent episodes of candidemia were excluded. Results One hundred and eighty-five of 248 patients were included. Fifty-six (30.3%) patients were obese and 129 (69.7%) were non-obese. Most were critically ill (55.1%), middle-aged (median 60 years), Hispanic or Latino (52.7%) and male (57.8%). Patients received micafungin 100 mg IV daily for a median of 6 (IQR 3-11.5) days. Obese patients had a higher Charlson Comorbidity Index of 4.5 (IQR 3-6.8) compared to 4 (IQR 2-6) in non-obese patients. Critically ill obese and non-obese patients had median Sequential Organ Failure Assessment scores of 10 (IQR 6.75-11.5) and 9 (IQR 4-12), respectively. Clinical and microbiologic failure at day 14 were numerically higher in obese patients ([44.6% vs 32.3%; p = 0.13] and [19.6% vs 10.1%; p = 0.10], respectively), while in-hospital and 30-day mortality were significantly higher in the obese population ([39.3% vs 22.5%; p = 0.03] and [44.6% vs 27.1%; p = 0.03], respectively). Conclusion Obese patients treated for candidemia with micafungin 100 mg IV daily had a significantly higher in-hospital and 30-day mortality. Clinical and microbiological failure followed a similar trend, without meeting statistical significance. Additional studies are warranted to determine whether higher doses of micafungin may improve outcomes in obese patients. Disclosures All Authors: No reported disclosures.

Candida Species Isolation from Hospitalized Patients with COVID-19-A Retrospective Study.

Coronavirus disease 2019 (COVID-19), a disease characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has so far led to hundreds of millions of infections and millions of deaths. Fungal infections are known to complicate COVID-19 patients and are associated with significant morbidity and mortality. The aim of this study was to assess the incidence of positive cultures for Candida spp. among patients hospitalized with COVID-19, describe their characteristics and identify factors associated with overall mortality in this patient population. Hospitalized COVID-19 patients with Candida spp. isolation were retrospectively assessed and their clinical, laboratory and microbiological characteristics were assessed and evaluated. In total, 69 patients with COVID-19 had a positive culture for Candida spp., representing a rate of 4.5% among all hospitalized COVID-19 patients. Their median age was 78 years (IQR 67-85 years) and 44.9% were male. Hospitalized patients with COVID-19 and Candida spp. isolation who died were older, were more likely to have a diagnosis of dementia, and had higher Charlson comorbidity index, higher Candida score and higher 4C score. Candida score was identified with a multivariate logistic regression analysis model to be independently associated with mortality. The most commonly identified Candida species was C. albicans, followed by C. tropicalis and C. glabrata and the most common source was the urine, even though in most cases the positive culture was not associated with a true infection. Thus, Candida score may be used in COVID-19 patients with isolation of Candida spp. from different body specimens for mortality risk stratification.

Machine Learning in Infectious Disease for Risk Factor Identification and Hypothesis Generation: Proof of Concept Using Invasive Candidiasis.

Machine learning (ML) models can handle large data sets without assuming underlying relationships and can be useful for evaluating disease characteristics, yet they are more commonly used for predicting individual disease risk than for identifying factors at the population level. We offer a proof of concept applying random forest (RF) algorithms to Candida-positive hospital encounters in an electronic health record database of patients in the United States. Candida-positive encounters were extracted from the Cerner HealthFacts database; invasive infections were laboratory-positive sterile site Candida infections. Features included demographics, admission source, care setting, physician specialty, diagnostic and procedure codes, and medications received before the first positive Candida culture. We used RF to assess risk factors for 3 outcomes: any invasive candidiasis (IC) vs non-IC, within-species IC vs non-IC (eg, invasive C. glabrata vs noninvasive C. glabrata), and between-species IC (eg, invasive C. glabrata vs all other IC). Fourteen of 169 (8%) variables were consistently identified as important features in the ML models. When evaluating within-species IC, for example, invasive C. glabrata vs non-invasive C. glabrata, we identified known features like central venous catheters, intensive care unit stay, and gastrointestinal operations. In contrast, important variables for invasive C. glabrata vs all other IC included renal disease and medications like diabetes therapeutics, cholesterol medications, and antiarrhythmics. Known and novel risk factors for IC were identified using ML, demonstrating the hypothesis-generating utility of this approach for infectious disease conditions about which less is known, specifically at the species level or for rarer diseases.

Association between Following the ESCMID Guidelines for the Management of Candidemia and Mortality: A Retrospective Cohort Study.

Objectives: The objective of this study was to evaluate the association between ESCMID adherence and 30-day mortality in candidemia. Methods: We performed a retrospective cohort study in two French tertiary-care hospitals. All patients with at least one positive blood culture (BC) for Candida spp. between January 2013 and December 2019 were included. An adherent case was defined as a candidemia case for which the treatment fulfilled a bundle of defined criteria based on the latest ESCMID recommendations. We explored factors associated with adherence to ESCMID recommendations in an unadjusted model, and we used a propensity score method to address potential channeling biases with regard to 30-day mortality. Results: During the study period, 165 cases of candidemia were included. Among the ESCMID criteria, funduscopic examination was not performed in 45% and neither was echocardiography in 31%, while the ESCMID criteria were fully implemented in 44 cases (27%). In the propensity score analysis, the all-cause 30-day mortality rate was significantly lower among adherent cases (3.4/36.6, 9%) than among nonadherent cases (42.4/119.5, 36%) (OR = 5.3 95% CI [1.6–17.1]). Conclusions: In our study, adherence to the bundle of criteria for candidemia management was associated with increased survival, supporting additional efforts to implement these recommendations.

Clinical Characteristics and Outcome of Candidemia: Experience from a Tertiary Referral Center in Saudi Arabia.

Background:Candida bloodstream infections cause significant excess morbidity and mortality in the health-care setting. There is limited evidence regarding Candida species causing invasive infections in Saudi Arabia.Objective:To identify Candida species causing bloodstream infection and determine the clinical outcome and factors associated with mortality in a tertiary center in Saudi Arabia.Materials and Methods:This retrospective study included all cases of positive blood culture for Candida in patients admitted to King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia, between January 1, 2013 and June 30, 2019.Results:A total of 532 patients with candidemia were identified (male: 55.4%; mean age: 54 ± 26.2 years). The most common Candida species isolated was Candida albicans (26.7%), followed by Candida glabrata (22.7%), Candida parapsilosis (22.2%), and Candida tropicalis (18.4%). Non-albicans candidemia was more common in patients with diabetes (76.7%; P = 0.0560), neutropenia (89.8%; P = 0.0062), recent exposure to fluconazole (85.7%; P = 0.0394), and active chemotherapy (83.1%; P = 0.0128). In non-albicans, susceptibility to fluconazole varied from 95.9% with C. tropicalis to 41.5% with C. parapsilosis; nonetheless, all species were highly susceptible to echinocandins. The overall 30- and 90-day mortality rates were 39.9% and 56.4%, respectively. The mortality rate was nonsignificantly higher with non-albicans species at 30 days (41.2% vs. 35.9%; P = 0.2634) and 90 days (58.2% vs. 51.4%; P = 0.1620).Conclusion:This study found a changing pattern in the Candida species causing bloodstream infections and an epidemiological shift toward more non-albicans Candida species in Saudi Arabia.