368. Community-Onset Candidemia: Trends Over 7 Years

Background Candidemia is often hospital acquired. With the inpatient–outpatient shift in healthcare, many cases are acquired in the community. We present a review of community-acquired candidemia. Methods We reviewed blood culture results (January 1, 2010–December 31, 2017), selected patients with candidemia, defined the place of onset (community onset [CO]: 0–3 days after admission; hospital onset [HO]: ≥4 days), the source and species distribution and compared CO and HO cases. Results We encountered 210 candidemia episodes. The rate of candidemia (0.6–1.2/1,000 discharges) and species distribution fluctuated without a clear trend. CO accounted for 92 (43.8%) episodes including 83 healthcare-related (CO-HC) and 9 (4.3%) without healthcare exposure (CO-A). CO/HO proportion did not significantly change over time. Source and species distribution were similar in CO and HO cases except for higher proportion of intravenous drug users (IVDA), soft tissue/bone (STB) sources, and a trend toward more UTI in CO (table). Comparison of cases with C. albicans and C. glabrata revealed that C. glabrata was more common in diabetics (51.5 vs. 33.0%; P = 0.005), and hemodialysis-dependent (H-D) cases (63.6% vs. 38.5; P = 0.04), and tended to be less common in UTI (25.9% vs. 45.4% in other sources; P = 0.09). Conclusion Candidemia remains a healthcare-related event but a significant portion is CO. CO-A is limited to IVDA and patients with comorbidities. Sources and species distribution was similar in CO-HC and HO cases except for more UTI in CO-HC. C. albicans remained more common but C. glabrata surpassed C. albicans among diabetics and H-D. Candidemia: Comparison of CO-A, CO-HC, and HO Cases. Results Represent. % Patient Characteristics Source Candida Species Onset (n) CA DM H-D IVDA VA AB UTI STB O-U alb gla Other CO-A (9) 11.1 11.1 0 44.4 0 33.3 22.2 33.3 22.2 44.5 33.3 22.2 CO-HC (83) 25.3 42.2 21.7 9.6 32.5 12.0 22.0 8.5 25.6 41.0 36.1 22.9 HO (118) 27.1 34.7 11.9 5.1 28.8 21.2 11.9 3.4 34.7 47.5 31.4 21.1 p a 0.4 0.9 0.4 0.002 0.5 0.5 0.08 0.004 0.1 0.5 0.8 0.8 Cancer; diabetes; vascular; abdomen/pelvis; urinary tract; soft tissue/bone; other-unknown; albicans; glabrata; a: chi square test. Disclosures All authors: No reported disclosures.