Background: Current treatment for invasive aspergillosis (IA) is suboptimal. The development of a standardized antifungal susceptibility testing method for molds (NCCLS microdilution method [M38-A]) has been a major advance. Inin our microbiology laboratory. Demographics, risk factors for candidemia, Candida species, treatment information, and outcome data were collected. Results: 81 pts with candidemia were identified during the study period. Mean age of pts was 51 yrs, 56% were white, 53% were female, and mean APACHE II score was 16.5. Follow-up blood cultures were obtained in 68%. 20 (27%) of 75 pts with candidemia were referred for ID consultation, and these had a lower mortality than pts without consultation (10% vs. 35%, P0.04). CVL were removed in 81% of pts and these pts had a trend toward lower mortality than pts who did not have removal of CVL (25% vs. 40%, P 0.24). Initial AF therapy agreed with IDSA GL in 80% of pts (80% medical pts, 79% surgical pts). Variation from IDSA GL included no AF Rx (5%), use of fluconazole when AmB was indicated (14%), and inappropriate use of lipid AmB (1%). Mortality was higher in pts whose initial AF Rx varied from IDSA GL versus those whose Rx followed IDSA GL (75% vs. 16%, P0.008); the difference was independent of APACHE II score. Conclusions: Management of candidemia at UAB was frequently consistent with IDSA guidelines: CVL were removed in 81% of pts and initial AF therapy agreed with IDSA GL in 80% of pts. Failure to obtain ID consultation and variation of therapy from IDSA GL were associated with higher mortality.
Full conference title:
41st Annual Meeting Infectious Diseases Society of America
- Infectious Diseases Society of America 41st