Background Candidemia is the fourth most common nosocomial blood stream infection with significant morbidity and mortality. Central lines have been considered a risk factor for invasive fungal infection. We evaluated the epidemiology, management, and outcomes of Candida CLABSI in an academic medical center.Methods We conducted a retrospective cohort study in a single academic center from January 1, 2011 to December 31, 2016 of patients who had positive blood cultures for Candida sp. and met CDC criteria for CLABSI. Outcomes measured were 30-day mortality and relapse or recurrence. Descriptive statistics were used to compare the outcomes of patients who had infectious diseases consult and managed per standard of care (SOC) as defined by IDSA guidelines and those without.ResultsOf 722 CLABSI cases, 82 (11%) were due to Candida sp. Candida species isolated were as follows: C. glabrata (40%), C. albicans (32%), C. parapsilosis (9%), and others (19%). Median age of pediatric patients was 2.25 years (range 0.5–6) and median age of adults was 59 years (19–92). Most common comorbidities were malignancy (35%) and end-stage renal disease (21%). Non-tunneled catheters were present in 58% of cases. Median time from line placement to candidemia was 15 days (IQR 8–29). Sepsis was present in 34 (42%) cases. Seventy-four (90%) cases were initiated on antifungal therapy (AFT) when culture turned positive. After Candida speciation, AFT was adjusted appropriately for 82 (100%) cases. IDC was present in 56 (68%), of which 41 (73%) followed SOC, whereas 15 (27%) did not. Two of 26 patients (8%) without IDC received SOC. Complications occurred in 11/82 (13%) (three endocarditis, two osteomyelitis, three endophthalmitis, and four septic thrombophlebitis). Cure was achieved in 26/82 (32%). Relapse or recurrence occurred in 15/82 (18%). The 30-day mortality for the cohort was 50%. Patients with IDC who received SOC had lower mortality compared with those who did not (35% vs. 67%, respectively; P = 0.03).Conclusion Candida CLABSI was infrequent but had significant mortality in our cohort. Our results suggest that adherence to SOC per IDSA guidelines and involvement of IDC may improve survival of patients with Candida CLABSI. Future studies are needed to validate these findings.Disclosures All authors: No reported disclosures.
Background: Hospital-acquired influenza (HA flu) lacks a consensus definition. However, it is known to be associated with increased inpatient morbidity and mortality. Objective: To describe the clinical course of HA flu in a cohort population. Methods: A retrospective cohort study was conducted at a tertiary-care adult and pediatric teaching hospital. Patients with HA flu during 3 seasons, 2016 through 2019, were identified from medical record information based on timing of the onset of signs and symptoms and positive virologic testing >72 hours after admission. Influenza infection was confirmed by multiplex respiratory PCR, influenza A/B PCR, or direct fluorescent antibody tests. Chart review was performed to abstract patient demographics and comorbidities, length of stay, testing, and timing to antiviral administration as well as diagnosis of pneumonia, coinfections, and 30-day mortality. Escalation of care during hospitalization was defined as a new requirement of supplemental oxygen, invasive or noninvasive ventilation, and transfer to an intensive care unit. Results: During the 3 flu seasons, 132 patients were identified with HA flu; 76 (58%) were women, 6 (4.6%) were aged <18 years, and 126 (95.4%) were adults. Annually, HA-flu patients accounted for 5%–7.8% of all patients hospitalized with laboratory-proven influenza. The median duration between hospitalization and positive flu test was 15 days, and the median length of stay after influenza diagnosis was 6 days. Antiviral treatment was received by 96% of the patients. In total, 41 patients (31%) showed radiographic evidence for pneumonia. Coinfection with either a viral or bacterial pathogen was identified in 25% of the cases. In addition, 26% of the patients experienced an escalation of care, and 20 patients (15%) were transferred to the intensive care unit after HA flu diagnosis. Furthermore, 4 deaths (3%) were attributed to influenza during their hospitalization. Conclusions: HA flu was a frequent cause for escalation in care and was associated with a mortality rate substantially higher than is typically seen in community-based populations with influenza. Coinfection was mostly related to bacteremia and pneumonia, yet not all pneumonias had an associated microbiological diagnosis other than influenza, and there was no significant association between coinfection and mortality. Future work should explore more precise definitions for HA flu as well as its complications.Funding: NoneDisclosures: None
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