Improved Survival of Candida CLABSI by Adherence to Standard of Care and Involvement of Infectious Diseases Consultant: A 5-Year Experience in a Single Academic Center

Abstract

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.

Impact of Infectious Disease Consultation in Patients With Candidemia: A Retrospective Study, Systematic Literature Review, and Meta-analysis

“…Candida species identification was available in 12 studies. C. albicans was the most common pathogen in all studies except for 1 study of patients with only C. glabrata fungemia [ 16 ] and 1 study of patients with CVC-associated bloodstream infection [ 22 ]. The source of candidemia was described in 4 studies (not including a study by John et al focusing only on CVC-associated bloodstream infection), and CVC-associated bloodstream infection was the most common source [ 8 , 9 ].…”

“…The source of candidemia was described in 4 studies (not including a study by John et al focusing only on CVC-associated bloodstream infection), and CVC-associated bloodstream infection was the most common source [ 8 , 9 ]. Seven studies evaluated 30-day mortality [ 8 , 9 , 17 , 18 , 20 , 22 ], 5 studies evaluated 90-day mortality [ 9 , 15 , 19 , 21 ], 2 studies evaluated 42-day mortality [ 7 , 15 ], 1 study evaluated 60-day mortality [ 8 ], 1 study evaluated 28-day mortality [ 16 ], and 1 study did not specify the time frame for mortality [ 23 ]. The mortality rate was lower in patients with IDC compared with non-IDC in all 13 studies ( Table 3 ).…”

“…Three studies included in the systematic review were excluded from meta-analysis because of unclear mortality numbers depending on IDC [ 20 , 22 ] or an unknown time frame for mortality [ 23 ]. Ten studies were included in the meta-analysis [ 7–9 , 15–19 , 21 ].…”