366. Impact of Obesity in Patients With Candida Bloodstream Infections. (26th November 2018)

• Record Type: Journal Article
• Authors: Barber, Katie E; Wagner, Jamie L; Miller, Jennifer; Lewis, Emily; Stover, Kayla R
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S143
• Page End: S144
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.377
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Candidemia contributes to prolonged hospitalizations, increased cost, and increased morbidity and mortality. Obesity worsens clinical outcomes for bacterial infections, though little is known about fungal infections. The purpose of this study was to assess if clinical outcomes differ in obese vs. non-obese patients with candidemia. Methods: This retrospective cohort study examined adult inpatients diagnosed with candidemia receiving >48 hours of antifungal therapy from June 2013 to December 2017. Patients with polymicrobial infections, dual systemic antifungal therapy, and chronic candidiasis were excluded. Obesity was defined as BMI ≥30 kg/m 2 . The primary outcome was infection-related length of stay. Secondary outcomes included time to bloodstream sterilization and in-hospital mortality. Results: Eighty patients were included: 28 obese and 52 nonobese. Median [IQR] age was 54 [39–63]; 55% males. Median weight was 103 [91–111] kg in obese patients vs. 61 [51–73] kg in nonobese patients ( P < 0.01). There were no differences in comorbidities (Charlson 3[1–5] obese vs. 3[1–5] nonobese; P = 0.72) or disease severity (Pitt bacteremia score 1[0–3] obese vs. 1[0–3] nonobese; P = 0.50). C. albicans (37.5%) and C. glabrata (30.0%) were the most frequently isolated species. Source control (34%) and time to source control (30 hours) were similar between groups, but ID consultation was more frequent in obese patients (82.1% vs. 55.8%; P = 0.02). Obese patients were more likely to receive micafungin as definitive therapy (57.1% vs. 21.2%; P < 0.01) with quicker initiation of definitive therapy (13 hours vs. 51 hours; P = 0.03). Duration of candidemia was 6[4.8–7] and 5[3–6] days in obese and nonobese patients ( P = 0.02). Both infection-related and total hospital lengths of stay were longer for obese patients at 19[10–42] vs. 12.5[8–19] ( P = 0.05) and 30.5[15–52] vs. 22[12–39] ( P = 0.19), respectively. In-hospital mortality was similar (obese: 21.4%, nonobese: 13.5%; P = 0.36). Conclusion: Despite quicker receipt of definitive antifungal therapy, more frequent ID consultation and echinocandin usage, obese patients had longer duration of candidemia, increased infection-related length of stay, and numerically higher mortality. Disclosures: All authors: No reported disclosures.