1424 - Factors Associated with Failure to Clear Candidemia Infection: Surveillance Data from Eight States, 2017

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Presenting Author(s)

DO

David H. Oh

Medical Student
Tufts University School of Medicine
San Leandro, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

ES

Emma Seagle

Public Health Analyst
Centers for Disease Control and Prevention, Mycotic Disease Branch
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SL

Shawn R. Lockhart

Senior Clinical Laboratory Advisor
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JN

Joelle Nadle

Project Coordinator
California Emerging Infections Program
Oakland, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

Devra Barter

Emerging Infections Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HJ

Helen Johnston

Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MF

Monica M. Farley

Division Director/Professor of Medicine
Emory University School of Medicine, Division of Infectious Diseases
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AR

Andrew Revis

Surveillance Officer
Foundation for Atlanta Veterans Education and Research/VA Health System, Georgia Emerging Infections Program
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BP

Brittany Pattee

Epidemiologist
Minnesota Department of Health
St. Paul, Minnesota
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EP

Erin C. Phipps

Principal Investigator, CDI/MuGSI/Candidemia Surveillance
University of New Mexico, Albuquerque, NM; New Mexico Emerging Infections Program, Santa Fe, NM
Albuquerque, New Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Brenda L. Tesini

Assistant Professor
University of Rochester
Rocheter, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AZ

Alexia Y. Zhang

Epidemiologist
Oregon Public Health Division-Acute and Communicable Disease Prevention
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WS

William Schaffner

Professor
Vanderbilt University Medical Center
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BJ

Brendan R. Jackson

Medical Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ML

Meghan Lyman

Medical Officer
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Candidemia is a bloodstream infection commonly associated with high morbidity and mortality. Failure to clear candidemia can lengthen hospitalization and treatment. Factors associated with candidemia clearance are unknown.

Methods: We analyzed 2017 candidemia surveillance data from the Centers for Disease Control and Prevention’s Emerging Infections Program. Data from eight sites (counties in California, Colorado, Georgia, Minnesota, New Mexico, New York, Oregon, and Tennessee) were included. Clearance was defined as having a blood culture negative for Candida ≤30 days after initial culture date (ICD). Cases with unknown clearance, unknown survival outcome, or death ≤30 days of ICD were excluded. Demographic and clinical factors associated with clearance were assessed with bivariate analysis using chi-square tests and multivariable logistic regression to calculate adjusted odds ratios (aOR) using backward selection (p-value< 0.10).

Results: Of 1,024 candidemia cases, 737 were included and 582 (79%) demonstrated clearance, of which 79% had evidence of clearance ≤5 days after ICD. In bivariate analysis, clearance was associated with central venous catheter (CVC) ≤2 days before ICD, CVC removal ≤7 days after ICD, and systemic antifungal medication within 14 days before ICD. Clearance was inversely associated with black race and admission from another hospital. In multivariable analysis, only race and admission from another hospital were significant predictors; age, sex, and CVC presence and subsequent removal were also retained for their clinical relevance. In the final model, clearance was less likely among black patients (aOR 0.51, 95% confidence interval [CI] 0.29-0.91) and those admitted from another hospital (aOR 0.28, 95% CI 0.11-0.75).Table 1. Bivariate associations for select variables between individuals with documented candidemia clearance and those without documented clearance in eight Emerging Infections Program surveillance sites, 2017

Conclusion: We found failure to clear candidemia infection to be associated with black race and prior hospital exposure, but not other factors previously shown to be associated (e.g., comorbidities, CVC presence). These associations could reflect illness severity, access to care, or other obstacles to effective treatment. Additional research is needed to investigate these associations further and identify other factors (e.g., treatment type and timing) to improve outcomes.