378. Candida auris Fungemia: Risk Factors and Outcome

BACKGROUND: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. Published clinical information on this organism consists primarily of case reports and small case series; thus, data from a single institution will allow us to examine risk factors for acquiring C. auris candidemia in comparison to other Candida species. METHODS: Aga Khan University Hospital Nairobi is a 280-bed referral center with 50 critical care beds. Candida species account for 34% of hospital acquired bloodstream infections (Maina et al., 2016). Blood cultures were monitored continuously using the Bactec and the VitekII was used for identification and susceptibility. The VitekII identified C. auris as Candida haemulonii, but species determinations were done for 21 of the isolates and all were identified as C. auris using published methods (Pfaller et al., 2012). RESULTS: From September 2010 to December 2016, 201 patients had 228 episodes of candidemia. Further analyses were performed only for first episodes. C. auris accounted for 38% of candidemia cases and 25% for C. albicans. A case–control analysis was done to compare patients with C. auris vs. Candida albicans fungemia. C. auris patients were more likely to be from critical care beds (78% vs. 52%; P = 0.003) and had been hospitalized longer (mean 33 days vs. 13 days; P < 0.001) prior to the positive blood culture. There was a trend toward more pre-existing renal failure (39% vs. 24%; P = 0.09) in C. auris patients and during the two weeks prior to candidemia, they were more likely to have central lines (84% vs. 54%; P ≤ 0.001). C. auris patients received a mean of 3.35 antibiotic classes vs. 2.6 for C. albicans (P = 0.02). 75% of C. auris patients received carbapenems vs. 54% for C. albicans (P = 0.02). Eighteen percent of C. auris patients had ≥14 days of candidemia, despite frequent lack of followup blood cultures. Prolonged candidemia was not associated with development of in vitro resistance. The crude mortality was 29%, compared with 36% for C. albicans and 39% for other Candida spp. (NS). CONCLUSION: These findings suggest an opportunistic pathogen that may be less virulent, but difficult to eradicate and that control efforts should focus on antimicrobial usage. DISCLOSURES: M. Castanheira, Allergan: Research Contractor, Research support. M. A. Pfaller, Allergan: Research Contractor, Research support.