362. Species Distribution and Trends of Invasive Candidiasis in the United States, 2009–2015, Using a Large Electronic Medical Record Database

BACKGROUND: While 50% of invasive candidiasis (IC) has historically been caused by C. albicans, the changing epidemiology and rise in drug-resistant Candida necessitates understanding the contribution of specific Candida species to IC. To date, species and site-specific trends in IC have not been reported on a large scale using US clinical data. METHODS: Using the Cerner Health Facts electronic health record (EHR) dataset, inpatient hospitalizations with any Candida spp. isolated from blood or a sterile site (SS) (abdominal or other) were identified from 2009 to 2015. Patient characteristics were described by species. Significant relationships (P ≤ 0.05) were assessed using chi-squared or exact binomial tests. Annual percent change in IC incidence by site and species were assessed via Poisson regression. RESULTS: Overall, 19,310 Candida isolates from 10,313 patients were identified. Of these, 46% of isolates were C. albicans, 22% C. glabrata, 14% C. parapsilosis, 7% C. tropicalis, and 11% other/unspeciated; no C. auris infections were identified. The overall incidence of IC was 99 cases/100,000 patients. Compared with C. albicans, isolation of other species was 35% more frequent from blood, and 43% and 30% less frequent from non-blood abdominal and non-abdominal SSs, respectively (Table 1). Total IC increased by 1% (95% CI = 0.2–2%) annually; while abdominal and SS IC significantly increased by 6% (4–8%) and 11% (9–13%) per year, respectively, candidemia decreased significantly by 4.5% (3–6%) annually. Among C. albicansinfections candidemia decreased by 6.5% (5–8%) annually, while abdominal (5%, 3–8%) and other SS infections (10%, 7–13%) increased (Figure 1). Candidemia incidence remained unchanged for the other species. SS infections increased for every species, and abdominal infections increased for all but C. parapsilosis (Figure 2). CONCLUSION: In this first large-scale study on trends in IC using US hospital EHR data, the species distribution of IC isolates varied between blood and non-blood SSs. The incidence of candidemia is decreasing, but not for potentially drug-resistant species such as C. glabrata, which continue to pose treatment challenges. This work was supported in part by the Division of Intramural Research, NIAID, NIH [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.