1154 - Characterizing fungemic outcomes among adult inpatients at a community teaching hospital: a retrospective cohort study

Background: Fungemia is among the highest causes of mortality and length of stay (LOS) within the inpatient setting. We aim to characterize outcomes in adult inpatients with fungemia at our institution.

Methods: Adult inpatients with at least one positive blood culture with yeast between January 1st, 2017 and December 31st, 2018 were retrospectively identified via an electronic health record report. Outcome measurements were stratified into three categories: demographic, infectious, and antifungal-related.

Results: Forty-five patients were identified for review.  The mean age was 62 years (SD 16.8) while the prevalence of fungemia among men and women was comparable (48.9 versus 51.1%). Diabetes (24.4%) and past malignancy (22.2%) were among the top comorbidities.  One in five patients received total parenteral nutrition at the time of positive blood culture results. Central lines were present in 66.7% of patients and were implicated as the source of infection in the majority of cases (31%). Intensive care unit (ICU) admission, 30-day mortality, and 30-day hospital readmission occurred in 66.7%, 24.4%, and 26.7% of patients, respectively. The median time to culture positivity and time to antifungal therapy after positive culture results were 42.5 (IQR 36.5 - 63) and 6.5 hours (IQR 2.75 - 12.5), respectively. Candida albicans was found to be the primary fungal pathogen identified among cases reviewed, isolated in 53.3% of patients. ID consultation occurred in 86.7% of cases. Caspofungin was the predominant empiric antifungal agent prescribed (50.8%). Median total duration of therapy was 14 days (IQR 11.5 - 19).

Conclusion: This analysis successfully identified key high-risk areas of attention in the clinical management of adult inpatients with fungemia at our institution. Central lines and ICU admission were predominant characteristics identified, suggesting the complexity of the management of these patients. Although 30-day mortality and readmission rates were found to mirror current national averages for this population, further risk-assessment of these outcomes would be appropriate to evaluate in a larger study cohort.