Risk Factors For Candidemia Research Articles

An Overview of Candidemia Patients in Tertiary Hospital, Surabaya, Indonesia

Candidaemia is a bloodstream infection (BSIs) caused by Candida spp. common in hospitalized patients. Candidemia has a high mortality and morbidity. This study aimed to give an idea about incidence, patient characteristics, species and patterns of candida susceptibility, and risk factors in candidaemia patients at Dr. Soetomo Hospital from January to December 2020. This is descriptive research using an observational research design. This study used a medical record instrument for candidemia patients in the inpatient ward of Dr. Soetomo and data in the form of records of blood culture results at the Clinical Microbiology Unit of RSUD Dr. Soetomo Surabaya for the period January-December 2020. The observed variables include incidence, sex, age, the origin of hospitalization, species distribution, frequency of antifungal sensitivity testing, and risk factors for candidemia. In 12 months, 53 candidemia patients were treated at Dr. Soetomo Hospital. The incidence of candidemia is 1.58 cases per 1000 person-years. Most of them are male (64.15%) and aged less than <1 year (28,30). Most of the medical units at the time of the diagnosis were intensive care units and pediatric wards (28.30%). Candida albicans was the most commonly found species (33.96%), then Candida tropicalis (26.41%) and Candida parapsilosis (24.53%). Two Candida glabrata isolates (40%) were susceptible to caspofungin, and all isolates (100%) of Candida albicans, Candida parapsilosis, Candida rugosa, Candida lusitaniae, Candida tropicalis, Candida dubliniensis, and were susceptible to the antifungals tested. Patients who use the Central Venous Catheter (CVC) have the highest level of risk factor, followed by patients with diabetes mellitus.

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

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

Opportunistic Candida Infections in Critical COVID-19 Patients.

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

P042 Identification, clinical profile, antifungal susceptibility pattern of candida auris from a tertiary care center in india

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectivesTo identify the phenotypic characteristics of Candida auris.To analyze the clinical profile of Candida auris infection.To describe the antifungal susceptibility pattern of Candida auris.MethodsThe study was conducted in the Department of Microbiology in Mycology division at Sri Ramachandra Institute of Higher Education and Research from December 2019 to November 2021. The study protocol was approved by Institutional Ethics Committee. Candida species isolated from various specimens sent to the laboratory were identified by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry (MALDI-TOF). The growth characteristics of C. auris were investigated on various media including Selective Auris Medium (SAM), HiChrome agar Candida and Tetrazolium reduction agar.Antifungal susceptibility testing was performed by using the Clinical and Laboratory Standards Institute broth microdilution method M27-A3. Antifungals tested were fluconazole, itraconazole, voriconazole, posaconazole, micafungin, anidulafungin, caspofungin and amphotericin B. Candida albicans American Type Culture Collection (ATCC) 22 019 was used as quality control strains.Data were collected for demographics, risk factors for candidemia, treatment, and outcome from the respective wards and ICUs.ResultsA total of 37 C. auris isolates were collected. Both adult and pediatric cases were included. The majority (23.3%) of the C. auris cases were seen in the age group of 55-64. Median age was 54 years for the adults. Among the 7 children, 6 were neonates and 1 was an infant. The most common source of isolation is urine and blood.A total of 35/37 isolates showed moderate to heavy growth on the SAM, while 2 isolates showed mild growth after 72 h. But all the other Candida species and other yeasts tested were inhibited on this medium. All the isolates of C. auris grew as cream to pinkish purple colonies on Hichrome agar Candida. On Tetrazolium reduction agar, all of them formed maroon colonies.The average duration of hospital stay was 25 days (range 4-65). A total of 35 of the patients were admitted to ICU, 8 had undergone mechanical ventilation and intubation. Central venous catheter was inserted in 9 patients and post-operative catheter placed in 6 patients; 4 patients had undergone tracheostomy and 25 of them had undergone some other invasive procedure. Total parenteral nutrition was received by 3 patients, 16 were diabetics and 11 were hypertensives. Prior antifungal exposure was present in 9 patients and 26 had received broad-spectrum antibiotics.The crude mortality rate with C. auris infection in patients was 32.43% and the attributable mortality rate, as considered by the treating physician was 10.81%.Antifungal resistance was noted to be amphotericin B (n = 15, 40.5%), fluconazole (n = 30, 81.1%), voriconazole (n = 4, 10.81%), itraconazole (n = 6, 16.21%), posaconazole (n = 5, 13.51%), caspofungin (n = 4, 10.81%). Multidrug resistance was noted in 15 (40.54%) isolates and 3 isolates (5.4%) were resistant to a drug from all three groups.Conclusion C. auris poses a great threat to immunocompromised individuals and those admitted in ICUs for long term.

P367 Candida sepsis in neonates a neglected pathogen: study from neonatal intensive care unit tertiary care hospital

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM IntroductionSignificance of Candida species in neonatal intensive care units (NICU) is increasingly being recognized. It is the third most common cause of late-onset sepsis in NICU patients and accounts for 9 to 13% of bloodstream infections (BSI) in neonates. Although Candida albicans has historically been the most frequently isolated species, recently non-albicans Candida (NAC) have emerged as an important opportunistic pathogen, notably Candida tropicalis, C. parapsilosis, C. krusei, C. glabrata, and C auris. This changing trend and the increasing use of azoles agents is now a matter of concern due to the emerging resistance of the non-albicans species to azoles.AimTo evaluate the Candida sepsis in neonates from neonatal intensive care units from a tertiary care hospital.Material and MethodsA cross-sectional study was conducted in the Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, East Delhi, India, during the period of July 2021 to December 2021. Overall, 30 suspected Candida sepsis patients from neonatal intensive care units were enrolled in the present study. The Candida spp. Isolated was identified as per standard mycological techniques. Preliminary identification was done by colony morphology on SDA, chromogenic media (Hichrome, Himedia Pvt. Ltd.), grown at 45°C, germ tube test, chlamydospore formation, and was confirmed by carbohydrate fermentation and assimilation tests. Antifungal susceptibility testing (AFST) was performed for Fluconazole (25 μg), and amphotericin B (AMB, 100 units) using the disc diffusion method on Muller-Hinton agar supplemented with 2% glucose and methylene blue (5 mg/ml). Zone diameters were interpreted as per the approved Clinical Laboratory Standards (CLSI-M44-A) guidelines. Quality control for AFST was performed using C. albicans-ATCC 90028 and C. parapsilosis-ATCC 22019.Statistical analysisThe statistical analysis was done using Statistical Package for Social Sciences (SPSS) version. The P-value ˂0.05 were considered as statistically significant.ResultOut of 30 Candida species from suspected septicemia neonates, non-albicans Candida (NAC) species accounted for (87%) compared to C. albicans (13.4%). Candida tropicalis was predominant at 9 (30%) followed by C. glabrata 8 (27%), C.parapsilosis 4 (13.3%), and C. krusei 3(10%), Pichia species (4.2%), and C.auris (3.4%). Antifungal sensitivity of the NAC isolates demonstrated >85% resistance to fluconazole amongst C. glabrata, C. parapsilosis, though amphotericin B had 100% sensitivity in all Candida species. The risk factor for candidemia as observed in our study were low birth weight 26(87%), use of broad-spectrum antibiotics 25 (83.4%), presence of an orogastric tube 18 (60%), and total parental nutrition 9 (30%) were significantly associated statistically (P <.05, paired t-test). The overall mortality amongst these neonates was 16.6%.ConclusionFungal BSI has emerged as an important cause of morbidity and mortality in neonates. Reporting of fungal bloodstream infections and the spectrum of species involved are essential measures in neonatal intensive care units in order to implement appropriate preventive and therapeutic strategies.

P050 Candida auris and non- auris candidemia in adult patients in a tertiary care set-up, New Delhi, India

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesThe aim of this study was to determine the species distribution, compare Candida auris and non-C. auris candidemia risk factors and antifungal susceptibility pattern of candidemia cases in adult patients at a tertiary care hospital, New Delhi, India.Materials and Methods Candida species identification was performed by phenotypic methods, VITEK (Biomerieux, France), and DNA sequencing (PGIMER, Chandigarh). The antifungal susceptibility was performed by broth microdilution method as per CLSI M27-A4 guidelines 2017.ResultsOut of 1274 blood samples, 70 samples (5.5%) yielded the growth of Candida species. There was a predominance of NAC spp. over C. albicans in candidemia patients. C. auris (12.85%, 9/70) and non-auris candidemia (87.14%, 61/70) was isolated in this study. In non-auris candidemia, C. tropicalis (28.57%, 20/70) was the predominant Candida species followed by C. parapsilosis (22.85%, 16/70), C. glabrata (14.28%, 10/70). Rare species among NAC spp. included C. mesorugosa, C. lusitaniae, C. krusei and C. haemulonii were isolated. The most common predisposing factor for C. auris and non-auris candidemia was urinary catheter (72.85%, 51/70) followed by an increased period of hospitalization (42.85%, 30/70), diabetes mellitus (21.5%, 15/70), etc. The significantly associated risk factor associated with C. auris was diabetes mellitus (P = .02). The overall resistance was 22.57% to all antifungal drugs. The multidrug resistance (MDR) was noted in 5.71% of isolates.ConclusionsEarly identification of risk factors, Candida speciation, and timely management are crucial for the outcome of candidemia cases. Non-albicans species were predominant over C. albicans depicting the change in the epidemiology and emergence of MDR Candida spp. like C. auris, C. glabrata, C. mesorugosa, C. lusitaniae, and Pichia kudriavzevii (C. kruseii). This warrants routine antifungal susceptibility testing (AFST) and close monitoring. The knowledge of local epidemiological profiles of Candida spp., accurate species identification, and their antifungal susceptibility is crucial for overall patient management.

Risk Factors and Clinical Outcomes of Candidemia Associated With Severe COVID-19

IMPORTANCE:COVID-19 can cause serious illness requiring multimodal treatment and is associated with secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear.OBJECTIVES:To describe clinical characteristics, outcomes and risk factors of candidemia among patients hospitalized with severe COVID-19.DESIGN, SETTING, AND PARTICIPANTS:A multicenter, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 and August 2021.MAIN OUTCOMES AND MEASURES:Chart review evaluating institutional and patient demographics, clinical and mycological characteristics, concomitant interventions (antibiotics, immunosuppressive agents, parenteral nutrition, degree of oxygen support, mechanical ventilation, surgery), treatment regimens, and outcomes (length of stay and discharge disposition)RESULTS:A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of patients received biologic for COVID-19. In-hospital mortality was significantly higher in the cases compared with the controls (68% vs 40%; p < 0.01). Candida albicans was the most common (53%), followed by C. glabrata (19%). Use of central lines, biologic, and paralytics were independent risk factors for candidemia.CONCLUSIONS AND RELEVANCE:Candidemia following COVID-19 infection is a concern that requires clinical consideration and patient monitoring. Risk factors for the development of candidemia in the setting of COVID-19 infection are largely consistent with traditional risk factors for candidemia in hospitalized patients.

Comparison of candidemia patient profile in COVID-19 and non-COVID-19 cases in a tertiary hospital in Surabaya, Indonesia

The COVID-19 pandemic has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. Risk factors for developing severe COVID-19 include older age, malignancies, obesity, immunocompromised conditions, and chronic diseases, many of which are also risk factors for candidemia. This study aimed to compare clinical characteristics of candidemia in patients with and without COVID-19. This retrospective study observe patients medical records from 2020 – 2021 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. A total of 131 candidemia cases (23 COVID-19 patients and 108 non-COVID-19 patients) were included during the study periods. COVID-19 cases had a higher rate of diabetes (60,9%, p=0,00), pulmonary disease (87%, p=0,00), obesity (34,8%, p=0,00), and having urinary catheter (69,6%, p=0,00). Non-albicans candida was the most common agent of candidemia in non-COVID-19 patients (91,3%, p=0,03). The susceptibility of fluconazole (80,6 v 56,5, p=0,01), caspofungin (82,4 v 60,9, p=0,04), amphotericin B (90,7 v 78,3, p=0,03) and flucytosine (92,6 v 73,9, p=0,00) were higher in non-COVID-19 patients. Based on the study result, it is important to take measures to prevent the transmission of Candida spp. with lower antifungal sensitivity that cause candidemia in COVID-19 patients.

Risk factors for candidemia: A case–control study

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

Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia

Background: An increase in candidemia has been observed throughout the world since the start of the COVID-19 pandemic. Patients with COVID-19 may have different risk factors, clinical presentations, and outcomes compared to patients without COVID-19. Methods: We conducted a retrospective chart review of all inpatients with candidemia at a large, academic medical center from April 30, 2019, to February 19, 2021. The first case of COVID-19 was detected at our institution March 2020 and patients were sorted into pre– versus post–COVID-19 pandemic groups. Data regarding clinical characteristics, risk factors, and outcomes were collected. The rate of candidemia per 10,000 patient days was calculated from January 2013 through February 2021. Results: In total, 202 patients were identified with candidemia: 92 cases were identified before the pandemic and 110 cases were identified after the pandemic began. Moreover, 33 (16.3%) patients were diagnosed with COVID-19 during the admission and 169 (83.7%) did not have COVID-19. Patients with COVID-19 were significantly more likely to be older (median, 64.5 vs 54.8 years; P = .0006) and to have a higher body mass index (32.8 vs 29.1; P = .03) than patients without COVID-19. Patients with COVID-19 were less likely have some of the traditional risk factors (eg, abdominal surgery, total parenteral nutrition, history of injecting drugs) for candidemia compared to patients without COVID-19. Patients with COVID-19 were significantly more likely to require ICU care (97.0% vs 67.5%; P &lt; .001) and to require mechanical ventilation (90.9% vs 53.9%; P &lt; .001), and they had higher mortality at 30 days (66.7% vs 31.4%; P &lt; .001). A multivariate logistic regression model showed that COVID-19 (OR, 2.53; 95% CI, 1.09–5.90) and higher age (OR 1.45, 95% CI, 1.11–1.91) were significant predictors of 30 day mortality. Using a Poisson regression model, the incidence rate ratio for candidemia per month after the start of the COVID-19 pandemic was 2.09 (95% CI, 1.85–2.36; P &lt; .0001) compared to the years prior. Conclusions: Rates of candidemia significantly increased after the start of the COVID-19 pandemic. Patients with candidemia in the post–COVID-19 era tend to have nontraditional risk factors, to be more critically ill, and to have increased mortality compared to patients in the pre–COVID-19 era. COVID-19 and higher age were independent predictors of mortality. More studies are needed to further define risk factors for candidemia in patients with COVID-19.Funding: NoneDisclosures: None

Candidemia in patients with head and neck cancer: mortality and a novel risk factor.

Candidemia is a bloodstream infection (BSI) by Candida spp. and is associated with high mortality. However, there have been few reports about BSI in head and neck cancer (HNC). We aimed to evaluate the impact of candidemia in patients with HNC and compared it with bacteremia. A multicenter retrospective study. We retrospectively analyzed 83 BSI episodes in HNC (2011 to 2020) and divided them into the candidemia and bacteremia groups. We then compared the survival rate and risk factors for candidemia between the groups. The overall cumulative incidence (risk) of candidemia in BSI was 12 out of 83 episodes (14.5%). The 1-year mortality for the bacteremia and candidemia groups was 33.3% and 58.3%, respectively (log-rank p = 0.041). Broad-spectrum antibiotics (odds ratio [OR]: 29.5; 95% confidence interval [CI], 2.49-350), mucositis (OR 11.0; 95% CI, 1.52-80.1), and malignant wounds (OR 79.5; 95% CI 1.33-4737) were significant risk factors for candidemia in HNC. Candidemia causes high mortality in patients with HNC. To our knowledge, malignant wounds have not been previously reported as a risk factor for candidemia. For early diagnosis and treatment of candidemia, risk factors should be considered, and antifungal therapy started earlier.

Incidence and risk factors for COVID-19 associated candidemia (CAC) in ICU patients.

BackgroundCritically ill COVID‐19 patients have a high risk for the development of candidemia due to being exposed to both well‐defined classical risk factors and COVID‐19‐specific risk factors in ICU.ObjectivesIn this study, we investigated the incidence of candidemia in critically COVID‐19 patients, and the independent risk factors for candidemia.Patients/methodsCOVID‐19 patients hospitalised in ICU during 1‐year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID‐19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded.ResultsOf 1229 COVID‐19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8–12.2, p < .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4–5.2, p < .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08–3–37, p < .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1–0.9, p < .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14–0.52, p < .0001) were significantly associated with candidemia.ConclusionsOur study filled the knowledge gap in the literature about the impact of COVID‐19‐associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID‐19 patients should be confirmed by further studies.

Epidemiology of candidemia in lung transplant recipients and risk factors for candidemia in the early posttransplant period in the absence of universal antifungal prophylaxis.

Lung transplant recipients are at increased risk of candidemia, especially in the early posttransplant period. However, the specific predisposing factors have not been established. The natural history of candidemia after lung transplantation, in the absence of universal antifungal prophylaxis, is not known. We retrospectively examined the epidemiology of candidemia at any time posttransplant in patients who underwent lung transplantation at our center between 2016 and 2019. We undertook a case-control study and used logistic regression to evaluate the risk factors for candidemia during the first 30 days posttransplantation. During the study period 712 lung transplants were performed on 705 patients. Twenty-five lung transplant recipients (LTRs) (3.5%) experienced 31 episodes of candidemia. The median time to candidemia was 19.5 days (IQR 10.5-70.5), with 61.2% (n = 19) episodes of candidemia occurring within the first 30 days posttransplantation. Pretransplant hospitalization, posttransplant ECMO, and posttransplant renal replacement therapy were associated with an increased risk of candidemia in the first 30 days posttransplant. Of those with candidemia in the first 30 days, 31.2% died within 30 days of the index positive blood culture. Candidemia was associated with decreased survival within 30 days posttransplant. This study highlights the greatest risk period of lung transplant recipients for development of candidemia and identifies several factors associated with increased risk of candidemia. These findings will help guide future studies on antifungal prophylaxis.

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

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

Risk and Predictive Factors for Candidemia After Allogeneic Hematopoietic Cell Transplantation: JSTCT Transplant Complications Working Group

Although antifungal prophylaxis that covers Candida species is a standard of care in allogeneic hematopoietic cell transplantation (HCT), candidemia mainly caused by non-albicans Candida species still occurs and is associated with a high mortality rate. This study aimed to evaluate the risk factors for candidemia after allogeneic HCT. Particularly, we evaluated the impact of patient factors such as hematopoietic cell transplantation–specific comorbidity index (HCT-CI) and performance status (PS) in addition to well-recognized risk factors including donor type, delayed engraftment, and graft-versus-host disease (GVHD). By using data from a Japanese transplant registry database, we analyzed 26,236 pediatric and adult patients with hematological malignancies who underwent their first allogeneic HCT. The posttransplant period was divided into early (days 0-40), late (days 41-100) and very late (days 101-365) phases. The 1-year cumulative incidence of candidemia was 1.8%. When we analyzed pretransplantation factors, age ≥40 years (hazard ratio [HR] 1.85), male (HR 1.34), HCT-CI (HCT-CI 1-2, HR 1.56; HCT-CI ≥ 3, HR 2.21), PS ≥ 2 (HR 2.01), high-risk disease (HR 1.78) and donor type including HLA-mismatched related donor (MMRD) (HR 1.96), HLA-mismatched unrelated donor (HR 2.05), and cord blood (CB) (HR 2.85) were significantly associated with an increased incidence of candidemia. Focusing on the early phase (days 0-40), HCT-CI, PS, high-risk disease and CB transplantation together with engraftment and severe acute GVHD significantly affected the development of candidemia. In the late phase (days 41-100), higher HCT-CI, male, and donor type including MMRD, and CB were associated with the occurrence of candidemia together with acute GVHD and disease relapse. In the very late phase (days 101-365), HCT-CI ≥ 3 and high-risk disease significantly affected the occurrence of candidemia together with acute and chronic GVHD, and disease relapse. In addition to well-recognized risk factors including donor type, engraftment and GVHD, patient factors such as HCT-CI and PS were associated with the development of candidemia, which suggests that severely ill patients with transplantation-associated complications are more likely to develop candidemia.

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.

Risk Factors for Candidemia in Intensive Care Unit: A Matched Case Control Study from North-Western India

Candidemia is one of the significant causes of mortality amongst critically ill patients in Intensive Care Units (ICUs). This study aimed to assess the incidence, risk factors and antifungal susceptibility pattern in candidemia cases admitted in ICU in a tertiary care hospital in Jaipur, Rajasthan from June 2021 to November 2021. Candida species isolated from blood culture of clinically suspected patients of sepsis were defined as candidemia cases. Blood culture and antifungal susceptibility testing were performed as per standard laboratory protocol. Analyses of risk factors was done between candidemia cases and matched controls in a ratio of 1 : 3. Forty-six candidemic cases and 150 matched controls were included in the study. C. tropicalis was the most prevalent species (22/46; 48%) followed by C. auris (8/46; 17%) and C. albicans (7/46; 15%). Candida species showed good sensitivity to echinocandins (97%) followed by amphotericin B (87%) and voriconazole (80%). In multivariate analysis, longer stay in ICU, presence of an indwelling device, use of immunosuppressive drugs and positive SARS-CoV-2 infection were associated with increased risk of candidemia. The constant evaluation of risk factors is required as prediction of risks associated with candidemia may help to guide targeted preventive measures with reduced morbidity and mortality.

Characteristics and Incidence of Candidemia in Hospitalized Coronavirus 2019 (COVID-19) Patients

Management of Coronavirus 2019 (COVID-19) with high-dose corticosteroids and interleukin-2 inhibitors has potential benefits, but is associated with immunosuppression and risk of secondary infections. This single-center, retrospective, cohort study evaluated the incidence of candidemia and associated risk factors in hospitalized COVID-19 patients. Twenty-three patients developed candidemia and were matched to 77 non-candidemic COVID-19 controls. The primary outcome was incidence of candidemia. Secondary outcomes included time to first positive fungal blood culture and antifungal initiation, antifungal treatment duration, fungal isolate identification, candidemia risk factors, in-hospital mortality, Intensive Care Unit (ICU) and hospital Length of Stay (LOS) and mechanical ventilation duration. Candidemia incidence was 0.7% (23/3101). Mean time from hospital admission to first positive fungal blood culture was 26.2±14.3 days, with systemic antifungal therapy initiated in 19 patients; seven started antifungal therapy the same day cultures were drawn and 12 within 24 h of preliminary culture results positive for yeast. The remaining four patients expired prior to culture results. Mean duration of antifungal therapy was 9.7±6.6 days. Candida albicans was the most frequently identified isolate. Candidemic patients were more likely to be admitted to the ICU, receive high-dose corticosteroid, renal replacement therapy, mechanical ventilation, central line, tocilizumab and broad-spectrum antimicrobials. They also had higher mortality (82% vs. 22%, p<0.0001) and longer ICU LOS (25 vs 0 days, p<0.0001), hospital LOS (39 vs 10 days, p<0.0001) and mechanical ventilation days (19 vs 0 days, p<0.0001). Candidemia occurrence is rare in COVID-19 patients, but can result in worse clinical outcomes such as high mortality and longer hospital stay. Clinicians should attempt to minimize risk factors and perform routine workup for systemic candida infections in COVID-19 patients in the ICU, on mechanical ventilation and with multiple risk factors.

979. Getting Candid with Candida auris: Evaluation of Isolates at SBH Health System

Abstract Background Candida auris is a multidrug resistant yeast that was originally isolated in the external ear of a patient in Japan in 2009. Since then, it has rapidly spread throughout the world. C. auris is inherently a multidrug resistant organism, making echinocandins the drugs of choice. C. auris was first isolated in SBH in a wound culture in 2018, and it has become a major health concern. Our objectives were to evaluate our clinical C. auris isolates, identify potential risk factors for infection, and assess our susceptibilities to determine the most appropriate treatment option. Methods This was a retrospective chart review of all clinical isolates of C. auris from July 2018 – April 2021. Data collection included location prior to admission, SBH hospitalization within 90 days, hospital vs community acquired, new vs recurrent, specimen type, susceptibilities, and lines at the time of culture. Results A total of 121 clinical isolates were evaluated from 74 patients. Although initially clinical isolates were rare, prevalence increased in subsequent years, with 97 clinical isolates identified in 2020. Isolates were identified in various specimen types, with the majority in urine, respiratory samples, or blood cultures. 64% of the isolates were hospital onset. Among patients who tested positive for C. auris colonization through surveillance testing, 22% proceeded to develop clinical infections. Most of the patients with positive blood cultures had either one or multiple IV access points, which may be a risk factor for candidemia. All isolates were resistant to fluconazole, 87% were susceptible to amphotericin B, and susceptibility to echinocandins ranged from 98-99%. Susceptibilities Susceptibilities for the Candida auris clinical isolates received from the NYS Department of Health Specimen Type IV Access in Positive Blood Cultures Access points that were present at the time of candidemia Conclusion Candida auris is a persistent fungus that is highly contagious that has been increasing in prevalence. Infection control measures remain the most proven method to decrease the development of clinical infections. Our study has some limitations, such as the retrospective design, the lack of a control group, lack of clinical outcomes, and limited surveillance testing capabilities. C. auris remains a major cause of concern for nosocomial infections, particularly in patients with various indwelling catheters. Our susceptibilities confirmed echinocandins as the class of choice for treatment of C. auris infections. Disclosures Judith Berger, MD, Nothing to disclose

709. Risk Factors for Candida auris Candidemia: Results from a Multicenter Case-Control Study

BackgroundThe emergence of Candida auris as a global pathogen has been described as a serious global threat by the CDC. It has caused outbreaks in healthcare settings as it is transmissible between patients. The risk factors for candidemia caused by C. auris may be different than candidemia caused by other Candida spp.MethodsWe performed a multicenter, retrospective case-control study at three hospitals in Brooklyn, New York between 2016 and 2020. Patients with at least one positive blood culture for Candida spp who were started empirically on an antifungal within 24 hours of blood culture positivity were included in the study. Subsequent cases in the same patient were excluded unless separated by at least 90 days from the initial case. Similar variables such as antibiotics and antifungals within the same drug class were compressed into one variable. Variables with a p-value ≤ 0.05 on univariate analysis were entered into a multivariable analysis with a p-value ≤ 0.05 considered to be statistically significant.Results84 cases of C. auris candidemia and 105 cases of candidemia caused by other Candida spp were included in the analysis. The most common species of other Candida spp was C. glabrata (N=33, 31.7%) followed by C. albicans (N=32, 30.4%). In the multivariable model, the strongest risk factor for C. auris candidemia was prior infection or colonization with C. auris (aOR 17.5; 95% CI, 1.60-192.93; P = 0.019) followed by prior infection or colonization with multidrug-resistant bacteria (aOR 6.97; 95% CI 1.49-32.74, P = 0.014). A history of peripheral vascular disease (PVD) (aOR 7.78; 95% CI 1.34-45.34, P = 0.023), cerebrovascular disease (CVA) (aOR 4.24; 95% CI 1.18-15.20, P = 0.027) and hemiplegia (aOR 6.43; 95% CI 1.19-34.85, P = 0.031) were also statistically significant. These risk factors remained significant analyzing only patients without any history of C. auris.ConclusionThese data suggest that in hospitalized patients with candidemia, a history of colonization or infection with C. auris, prior infection or colonization with multidrug-resistant bacteria, as well as a history of PVD, CVA, and hemiplegia are associated with C. auris candidemia. Disclosures Samuel Simon, PharmD, Accelerate Diagnostics (Employee)