367. Influence of Body Weight and Outcomes in Candidemia

BACKGROUND: Obese patients may have altered pharmacokinetic parameters when compared with normal weight patients due to their body habitus and altered drug clearance. Case reports suggest higher echinocandin dosing may be needed to reach adequate serum concentrations in obese patients. The purpose of this project is to compare patient outcomes between normal weight and overweight patients that receive an echinocandin for candidemia. METHODS: IRB approved, retrospective cohort at five hospitals with an antimicrobial stewardship program. Dates: January 1, 2014–January 31, 2018. Included: ≥18 years, Candida species positive blood culture or T2MR, anidulafungin FDA label dose for ≥72 hours. Exclusion criteria: neutropenia, endocarditis, osteomyelitis, meningitis, immunosuppression. Primary outcome: 30-day all-cause mortality. Secondary outcomes: 14-day global clinical cure rates, Candida eye involvement, recurrence, antifungal restart, and optimal azole dose. RESULTS: One hundred seventy-three patients included: 121 blood; 73 T2MR. Obese: more female, pulmonary disease. Underweight: less surgery. Most common species: C. albicans (33%), C. glabrata (33%). More C. parapsilosis in obese (36.4%). Low anidulafungin minimum inhibitory concentrations (MIC) in all groups, but elevated in C. parapsilosis. No association between body mass index and mortality: underweight (36.4%), normal (25.8%), overweight (32.0%), obese (33.9%), morbidly obese (31.8%). See Table 1 for variables associated with mortality. No differences in quality of management, recurrence, Candida eye involvement, antifungal restart, optimal azole dose. More global cure in survivors. CONCLUSION: We were unable to detect a difference in mortality in patients with candidemia by weight group. Line removal and receipt of ≥5 days of anidulafungin were protective. DISCLOSURES: S. Davis, Achaogen: Consultant and Scientific Advisor, Consulting fee. Allergan: Consultant and Scientific Advisor, Consulting fee. Melinta: Consultant and Scientific Advisor, Consulting fee. Nabriva: Consultant and Scientific Advisor, Consulting fee. Zavante: Consultant and Scientific Advisor, Consulting fee.