Central Line-Related Candida glabrata Fungemia: Diagnostic Performance of Time-To-Reporting of Positive Blood Cultures

Author:

Dimitrios Farmakiotis, MD Jeffrey J. Tarrand, MD Dimitrios P. Kontoyiannis, MD, ScD, FIDSA

Full conference title:

IDWeek 2015 San Diego, CA

Date: 14 November 2017

Abstract:

Background. Central venous catheter (CVC) removal is beneficial in patients with CVC-related candidemia, defined as a higher colony count in a catheter lumen, compared to peripheral blood. However, clinicians are often faced with a blood culture growing Candida in a patient with a CVC, and few laboratories perform quantitative cultures. Therefore, it was proposed that short time-to-culture positivity (TTP) can be suggestive of catheter-related candidemia, in series of predominantly C. albicans candidemia episodes. Given the epidemiologic shift to non-albicans Candida species, and the longer time to detection for C. glabrata, compared to other Candida species, we studied the clinical characteristics of patients with CVC-related C. glabratafungemia and the diagnostic utility of time-to-reporting (TTR) of positive blood cultures.

Methods. We included patients with at least one blood culture(s) positive for C. glabrata, a CVC and available TTR, seen at MD Anderson Cancer Center between March 2005 and September 2013. CVC-related candidemia was defined as a colony count in a blood culture obtained via the CVC at least fivefold greater than the colony count in peripheral blood.

Results. Fifty-six of 119 patients studied (49%) were deemed to have CVC-related candidemia. Those patients were less likely to be on total parenteral nutrition (TPN, 34 [42%] versus 48 [59%] of those with non-CVC-related candidemia, P = 0.01), or have an absolute neutrophil count <100/μL (2 [4%] versus 13 [22%], P < 0.01). TTR was shorter in patients with CVC-related candidemia (mean ± standard deviation, 67 ± 35 hours) compared to those with non-CVC-related candidemia (79 ± 31 hours, P < 0.01), and had significant diagnostic value by ROC analysis (figure). A TTR <48 hours was 99% specific for CVC-related candidemia.

Conclusion. Among patients with C. glabrata fungemia, an abdominal source was more likely than CVC-related candidemia in severely neutropenic patients and in those receiving TPN. In the evaluation of patients with C. glabrata fungemia, a TTR of <48 hours could further support the decision to remove the CVC.

Disclosures. All authors: No reported disclosures.

Conference Year: 2015

Link to conference website: IDWeek 2015

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