SAN FRANCISCO — Study findings presented at IDWeek indicate that obese patients with candidemia experience worse outcomes than nonobese patients, including longer duration of infection, increased infection-related length of stay and numerically higher mortality.
According to Katie E. Barber, PharmD, assistant professor of pharmacy practice at the University of Mississippi School of Pharmacy, and colleagues, although it is known that obesity is associated with worse clinical outcomes for bacterial infections, the relationship between fungal infections and obesity is unclear.
“Closer monitoring and follow-up of obese patients with fungal bloodstream infections should be performed,” Barber told Infectious Disease News. “Aggressive education on appropriate dosage, including empiric anti-fungal therapy, is warranted.”
Barber and colleagues retrospectively examined 80 adult inpatients diagnosed with candidemia. Patients were eligible for inclusion in the study if they received more than 48 hours of antifungal therapy between June 2013 and December 2017. Patients with polymicrobial infections, chronic candidiasis or receiving dual systemic antifungal therapy were excluded.
The primary outcome of the study was infection-related length of stay. Duration of candidemia, in-hospital mortality and presence of an ID consultation were secondary outcomes.
According to Barber and colleagues, of the 80 eligible patients, 28 were classified as obese — BMI of at least 30 kg/m2 — and 52 were nonobese. The median age was 54 years and 55% of patients were male. In obese patients, the median weight was 102.5 kg. It was 61.4 kg in non-obese patients (P < .01).
Barber and colleagues reported no observable differences in comorbidities or disease severity among participants. The most frequently isolated Candida species among both obese and nonobese patients included in the study were Candida albicans and Candida glabrata.
According to the findings, ID consultations were more frequent for obese patients, occurring 82.1% of the time compared with 55.8% for nonobese patients (P = .02). Obese patients also were more likely to receive micafungin as definitive therapy, 57.1% vs. 21.2% (P < .01), the researchers reported.
For obese and nonobese patients, duration of candidemia was 6 and 5 days, respectively (P = .02), and infection-related and total lengths of stay were longer than in nonobese patients, 19 vs. 12.5 days and 30.5 vs. 22 days, respectively, Barber and colleagues reported. They noted statistically similar rates of in-hospital mortality in obese and nonobese patients at 21.4% and 13.5%, respectively (P = .36).
The researchers noted that obese patients experienced worse outcomes despite quicker definitive antifungal therapy, more frequent ID consultation on their cases and echinocandin use.
“Obese patients with Candida bloodstream infections, irrespective of optimal management, had worse clinical outcomes than patients that were non-obese,” Barber said. – by Marley Ghizzone
Barber KE, et al. Abstract 366. Presented at: IDWeek; Oct. 3-7, 2018; San Francisco.
Disclosures: The authors report no relevant financial disclosures.