Epidemiology, Risk Factors and Outcomes of Candida Empyema: A 5-Year Single-Centered Experience

BACKGROUND: Candida empyema is a rare manifestation of invasive candidiasis and can occur as a result of candidemia or direct inoculation of the pleural space after thoracic or abdominal surgeries. The risk factors and outcomes of candida empyema are poorly defined. METHODS: We performed a retrospective descriptive analysis of all patients that had Candida species isolated from pleural fluid, from May 2012 to April 2017 at our institution. RESULTS: Sixty patients with Candida empyema were identified. Patient characteristics are shown in Table 1. The majority of patients 68% had contiguous surgery and 25% had recent solid organ transplantation most of these were lung/heart transplants. The majority isolates were non-Candidia albicans species (52%). Fifty-two patients (86.7%) received antifungals treatment for empyema: 72% received an azole and 13% received an echinoncandin. Fluconazole was the most frequent antifungal (63.3%). Mean duration of treatment was 4 weeks. Of these patients 78% underwent chest tube drainage (40% before diagnosis, 39% after diagnosis) and 22% required VATS/decortication. The overall 30-day mortality was 30%. Candidemia was noted in seven patients (11.7%). Thirty-day mortality was associated with sepsis OR 1.04–11.4, P = 0.049, history of diabetes P = 0.045 and sepsis at the time of candida isolation. A history of solid organ transplantation had a negative effect on mortality OR 0.01–1.07. CONCLUSION: Candida empyema was associated with recent contiguous surgery in the majority of cases including lung/heart transplants. Candida empyema is associated with significant mortality despite antifungal treatment and drainage as was associated with sepsis syndrome and diabetes. DISCLOSURES: All authors: No reported disclosures.