368. Community-Onset Candidemia: Trends Over 7 Years

BACKGROUND: Candidemia is often hospital acquired. With the inpatient–outpatient shift in healthcare, many cases are acquired in the community. We present a review of community-acquired candidemia. METHODS: We reviewed blood culture results (January 1, 2010–December 31, 2017), selected patients with candidemia, defined the place of onset (community onset [CO]: 0–3 days after admission; hospital onset [HO]: ≥4 days), the source and species distribution and compared CO and HO cases. RESULTS: We encountered 210 candidemia episodes. The rate of candidemia (0.6–1.2/1,000 discharges) and species distribution fluctuated without a clear trend. CO accounted for 92 (43.8%) episodes including 83 healthcare-related (CO-HC) and 9 (4.3%) without healthcare exposure (CO-A). CO/HO proportion did not significantly change over time. Source and species distribution were similar in CO and HO cases except for higher proportion of intravenous drug users (IVDA), soft tissue/bone (STB) sources, and a trend toward more UTI in CO (table). Comparison of cases with C. albicans and C. glabrata revealed that C. glabrata was more common in diabetics (51.5 vs. 33.0%; P = 0.005), and hemodialysis-dependent (H-D) cases (63.6% vs. 38.5; P = 0.04), and tended to be less common in UTI (25.9% vs. 45.4% in other sources; P = 0.09). CONCLUSION: Candidemia remains a healthcare-related event but a significant portion is CO. CO-A is limited to IVDA and patients with comorbidities. Sources and species distribution was similar in CO-HC and HO cases except for more UTI in CO-HC. C. albicans remained more common but C. glabrata surpassed C. albicans among diabetics and H-D. DISCLOSURES: All authors: No reported disclosures.