383. An Increased Rate of Candida parapsilosis Infective Endocarditis Is Associated With Injection Drug Use

BACKGROUND: Candida parapsilosis fungemia typically occurs in patients with intravascular catheters or prosthetic devices. In 2017, we noted an increase in C. parapsilosis infective endocarditis (IE). METHODS: We retrospectively reviewed C. parapsilosis fungemia and IE from January 2015 to February 2018. Species were identified using MALDI-TOF, and confirmed by ITS sequencing. RESULTS: Between 2010 and 2017, there was no increase in cases of C. parapsilosis fungemia (mean: 13/year), but there was a significant increase in C. parapsilosis IE (P = 0.048) (Figure 1). From January 2015 to February 2018, 22% (12/54) of C. parapsilosis fungemia was complicated by IE. Demographics of C. parapsilosis fungemia included: community-acquired infection (87%), presence of vascular catheters (80%), opiate noninjection drug use (non-IDU, 44%), IDU (20%), and presence of cardiac devices (18%). Ninety-one percent (49/54) of C. parapsilosis fungemia was caused by C. parapsilosis sensu strictu (Cpss); C. orthopsilosis and C. metapsilosis accounted for 4% (2/54) each (1 isolate could not be subtyped). Cpss, C. orthopsilosis, and C. metapsilosis accounted for 83% (10/12), 8% (1/12), and 8% (1/12) of IE, respectively. Ninety-two% (11/12) of C. parapsilosis IE was left-sided, and 33% (4/12) involved multiple valves. Risk factors for C. parapsilosis IE were past or active IDU (P < 0.001), community-acquired fungemia (P = 0.02), prosthetic heart valve (P = 0.01) or implanted cardiac device (P = 0.03). Receipt of an antibiotic within 30 days was a risk for C. parapsilosis fungemia without IE (P = 0.001). Median age for IE vs. fungemia was 38 vs. 57 years (P = 0.09). By multivariate logistic regression, IDU (P < 0.0001), prosthetic valve (P = 0.006) or implanted cardiac device (P = 0.04) were independent risks for C. parapsilosis IE. 70% (7/10), 20% (2/10), and 10% (1/10) of patients with IDU and C. parapsilosis IE primarily used heroin, buprenorphine/naltrexone, and cocaine, respectively. 50% (6/12) of patients with C. parapsilosis IE underwent surgery; most common initial AF regimens were caspofungin and amphotericin B. Nonsurgical patients were suppressed with long-term azole; one relapsed requiring surgery. Thirty-day and in-hospital mortality for patients with fungemia vs. IE were 32% vs. 17% and 26% vs. 17%, respectively. CONCLUSION: C. parapsilosis IE has emerged at our center. Unique aspects of C. parapsilosis pathogenesis that may account for emergence are a propensity to colonize skin, adhere to prosthetic material and form biofilm. C. parapsilosis IE may be an under-appreciated consequence of IDU and opioid abuse. [Image: see text] DISCLOSURES: All authors: No reported disclosures.