(543) Characteristics of Deceased ICU Patients With Candida Versus Bacterial Bloodstream Infections

Introduction: Candida bloodstream infections (BSI) are a significant cause of mortality, and these infections are particularly prevalent in the intensive care unit (ICU). Despite the threat posed by Candida BSI, there has been little research comparing clinical differences between patients with Candida and bacterial BSI. This study aims to differentiate the clinical characteristics of patients who died in the ICU with Candida versus bacterial BSI.

Methods: We analyzed all patients in the MIMIC-IV database with a first BSI, and separated patients into Candida BSI vs. bacterial BSI groups. Clinical characteristics of deceased patients in each group were compared using R statistical software.

Results: We included 2564 patients, of whom 311 (12.1%) had a Candida BSI and 2253 (87.9%) had a bacterial BSI. 562 patients (21.9%) died during their ICU stay; a significantly higher proportion of Candida BSI patients died (39.2%) than bacterial BSI patients (19.5%) (OR 2.66, 95 CI 2.05-3.44, p< 0.0001). Among deceased patients, at the time of positive culture Candida patients were more likely than bacterial patients to be on a ventilator (50.0% vs 28.4%, p< 0.0001), be on one or more vasopressors (32.0% vs 15.0%, p< 0.0001), or be receiving renal replacement therapy (18.9% vs 5.23%, p< 0.0001). Candida patients were also younger (64.9 vs 68.2, p< 0.0001) and more evenly divided by gender than bacterial patients (50.2% female vs 38.0% female, p=0.014).

Conclusions: ICU patients with Candida BSI who died were overall more acutely ill (as determined by need for mechanical ventilation, vasopressors, and renal replacement therapy) and younger than those with other BSIs who died. These findings highlight the significant mortality associated with Candida BSI among critically ill patients, as well as the high ICU intervention usage associated with Candida BSI. Urgent strategies are needed to avert Candida BSI and improve outcomes of this frequently fatal infection in ICU patients.