# 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.

## Key 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