P-1107. Evaluation of Candidemia and Antifungal Use in ECMO Patients at a Large Volume ECMO Center

TL;DR

This study examines candidemia and antifungal use in ECMO patients, finding high rates of infection and antifungal use, with potential for improved diagnostic and treatment strategies.

Contribution

The study provides new insights into candidemia and antifungal use in ECMO patients, emphasizing the role of rapid diagnostics and stewardship opportunities.

Findings

11.9% of ECMO patients had a positive T2C result or blood culture for Candida, with 6% having blood culture-proven candidemia.

Antifungal therapy was used on 21.8% of ECMO run days, with micafungin being the most common agent.

T2C testing showed high concordance with blood culture in confirmed cases but lower concordance in T2C-positive cases.

Abstract

Candida species are a common cause of bloodstream infections in patients receiving Extracorporeal Membrane Oxygenation (ECMO) therapy and a driver of morbidity and mortality. [1, 2]. Risk for candidemia is higher with VV ECMO and duration on ECMO therapy >3 weeks [3]. There is little data describing antifungal use in ECMO or on the use of rapid diagnostic testing with T2Candida (T2C) to identify candidemia in these patients.

We conducted a retrospective cohort study of adult patients requiring ECMO from 1/1/2021-12/31/2023. Only the first 30 days of ECMO and first ECMO run was included in the analysis. Candidemia was defined as identification of Candida species in at least 1 culture bottle. Antifungal use was documented over the duration of their ECMO run, or up to 30 days.

A total of 403 ECMO patients and 5,660 ECMO days were included. Patient demographics are shown in Table 1. Of the 403 patients, 48 (11.9%) had a positive T2C result or blood culture for candida isolate and 29 (6%) had blood culture proven candidemia. T2C testing was performed in 33% of confirmed candidemia cases and showed a high rate of concordance with the blood culture (p< 0.0001). However, T2C positive cases had blood culture performed in 64% and had lower concordance rate (38.9%) (Table 2). There were 4 cases of candidemia with organisms not detectable by T2C.

Antifungal therapy was administered on 1,232 run days (21.8%) across 182 ECMO runs (45.2%). Median duration of therapy was 4 days [IQR 2-9 days]. The most used antifungal was micafungin (Table 3). There was a statistically significant difference in antifungal exposure with immunocompromised patients receiving longer courses of antifungal therapy (median 6 days vs 4 days, p = 0.0131) and greater number of ECMO days with antifungal therapy (p = 0.0052).

The rate of candidemia in our ECMO cohort was high compared to other high risk populations such as stem cell transplant [4]. Antifungal use was also high and not necessarily pathogen directed, suggesting an opportunity for stewardship or targeted prophylaxis. Finally, our cohort included T2C testing which accounted for 40% of cases. Recognizing the limitations of culture sensitivity, the role for rapid molecular diagnostics in this population warrants further study.

Owen Albin, MD, Biomerieux: Advisor/Consultant|Biomerieux: Grant/Research Support|Charles River Laboratories: Advisor/Consultant Todd P. McCarty, MD, Basilea: Grant/Research Support|Cidara: Grant/Research Support|F2G: Grant/Research Support|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant|Scynexis: Grant/Research Support

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