365. Candida Bloodstream Infections in a Tertiary Care Hospital in Costa Rica, 5-Year Experience

Abstract

Background. Invasive fungal bloodstream infections (BSI) display high morbidity and mortality. Epidemiologic data from Central America, including geographic distribution and mortality is scarce. Methods. Patients of all age groups with a positive Candida spp. blood culture from January 2012 to December 2017. Only initial episodes was accounted per patient. Demographic data was retrospectively collected and analyzed. Between-group difer-ences were compared using Chi2, logistic regression used to calculate odds ratios, and survival analysis using Kaplan Meier. Results. 243 episodes of Candida spp. BSI occurred during the study period, increasing over time. A median 21 days of hospital stay to the first episode of can-didemia (IQR 14-32). Candida albicans represented 51% of episodes, followed by C. parapsilosis 27%, C. glabrata 9%, C. tropicalis 9%, C. haemulonii 1.6%, C. krusei, C. pelliculosa, C. guilllermondi. Male sex predominated (62%) over females (38%), median age was 54 years. Age group distribution corresponded to 23 newborns (9%), 6 adolescents (3%), 141 adults (58%), and 72 elders (30%). Surgical wards and surgical ICU comprised for 47% of cases. Admission for intraabdominal pathology; 35% of cases, followed by cancer 21% (63% solid tumors, 37% hematologic malignancies), 11% trauma and orthopedic surgery. Overall resistance rates were 14% fuconazole, 5% voriconazole and 8% for amphotericin B, no resistance to echinocandins detected. Overall mortality was 69%. Mortality by species C. krusei 100%, C. tropical 95%, C. gla-brata 81%, C. albicans 68%, C. parapsilosis 59%, C. haemulonii 50%, (P = 0.02). No fatalities occurred with C. pelliculosa and C. guillermondi. Mortality was highest in elderly (69%), followed by adults (65%) and adolescents (50%) (P = 0.039). Death OR was 2.13 for elders vs. the adult group (P = 0.02, CI 1.097-4.155). A negative correlation was documented between age group and survival (rho -0.3250 P < 0.00001). Conclusion. Candida BSI show an increasing trend over time in our cohort. Candida parapsilosisis as the second cause of candidemia displays lower mortality than its counterparts. Mortality was higher than previously reported and is highest in the elderly. Antimicrobial stewardship programs, source control in abdominal surgeries and appropriate central venous catheter use need to be implemented to improve outcomes.