2447. Clinical Features and Outcome of Persistent Candidemia Caused by Candida albicans versus Non-albicans Candida Species: A Focus on Antifungal Resistance and Follow-up Blood Cultures

Background Candidemia is a common hospital-acquired (HA) infection linked to extended hospitalization and high mortality rates. Risk factors for persistent candidemia (PC) include central venous catheter, empirical treatment, and metastatic infection foci. Antifungal resistance is a significant global infection control issue, especially in non-albicans Candida species. We investigated clinical outcomes and mortality rates associated with HA-PC, focusing on Candida species, antifungal resistance, and PC-clearance. Methods Data analysis was conducted using electronic medical records from Tohoku University Hospital from 2012 to 2021 (n = 60). HA-PC cases were categorized based on Candida species, azole or echinocandin resistance, and PC-clearance status, and analyzed respective characteristics. The primary outcome variables were 30-day, 30–90-day, and 90-day mortality after the initial blood culture. Results The HA-persistent non-albicans candidemia group had a higher ratio of immunosuppression and catheter-related bloodstream infection (CRBSI) than the HA-persistent Candida albicans bacteremia group (Odds ratio [OR] = 4.6, p = 0.049). CRBSI was more prevalent in the HA-PC resistant strain group than in the susceptible strain group (OR = 4.2, p = 0.008), while HA-PC resistant strain group had a lower incidence of intraocular candidiasis (p = 0.020). Mortality rates were slightly higher in the HA-persistent non-albicans candidemia group compared to the HA-persistent Candida albicans bacteremia group. Similarly, the HA-PC resistant strain group tended to have higher mortality rates compared to the susceptible strain group. In the HA-PC non-clearance group, there was a trend towards higher 30-day, and 90-day mortality rates, and the former group had a statistically significant difference (OR = 19, p = 0.028). Conclusion Patients with HA-PC caused by non-albicans Candida or azole or echinocandin resistant strains have higher mortality rates and require careful therapeutic management. Confirming the clearance of PC by performing follow-up blood cultures can improve the survival rate for both susceptive and resistant strain groups. Disclosures Shiori Kitaya, MD, AMANO Co., Ltd.: Grant/Research Support Hajime Kanamori, MD, PhD, MPH, Amano Co., Ltd.: Grant/Research Support Koichi Tokuda, MD, PhD, MPH, AMANO Co., Ltd.: Grant/Research Support