LAUSR

Abstract Background Breakthrough invasive candidiasis (bIC) has been described in adults, but the epidemiology and outcomes in children are unknown. Methods Retrospective cohort analysis of children diagnosed with IC from 9/1/09 to 1/30/17. bIC was defined as isolation of Candida spp. from sterile site despite receiving ≥3 doses of antifungal (AF) to which isolate is susceptible. Clinical and microbiological data, management, and outcomes were collected. Non-parametric and logistic regression statistics were applied. Results There were 92 patients with IC, 23 of which were bIC (Table 1). Underlying conditions included GI (n = 26), hem/onc (n = 17), prematurity (n = 16), cardiac (n = 15), HCT (n = 4), SOT (n = 5), and other (n = 9). Patients received an azole (n = 17), micafungin (n = 5), or amphotericin B (n = 1) for median of 20 days [3–522] before bIC as: prophylaxis (n = 8), targeted therapy (n = 5), or empiric fever driven therapy (n = 10). bIC was caused by non-albicans Candida in 16/23 (70%) cases. Compared with IC controls, children with bIC had increased ICU admission, vasopressor use, mechanical ventilation, and renal failure (all with P < 0.01). In multivariate analysis, immunosuppression was an independent risk factor for bIC (OR 39.4, 95% CI 7.5–205). Death attributable to IC occurred in bIC group (n = 3, P = 0.04). Conclusion bIC in our cohort was caused most frequently by non-albicans Candida spp. and associated with significantly worse outcomes, including mortality. Variable (N, %) Controls (N = 69) bIC (N = 23) P-value Age, in years; median (range) 3 (4 days–32 years 2 (11 days–28 years] 0.78 Male 33 (47) 16 (11) 0.09 Indwelling catheter Central venous 35 (51) 14 (61) 0.03 Peripherally inserted central 27 (39) 14 (61) 0.09 Neutropenia (ANC < 500) 4 (6) 5 (22) 0.04 Corticosteroidsa 6 (9) 19 (83) <0.01 Chemotherapy 7 (10) 8 (35) 0.01 TPN 41 (59) 17 (74) 0.32 Antibiotics 37 (53) 18 (78) 0.03 Days prior to IC 4 [1–109] 12 [1–56] 0.02 Clinical diagnosis Primary siteb + Candidemia 1 (1) 4 (17) Isolated candidemia + catheter 48 (70) 13 (57) Isolated candidemia NO catheter 6 (9) 0 CNS 4 (6) 0 Peritoneal 8 (11) 2 (9) Osteomyelitis 2 (3) 0 Disseminated 0 4 (17) Days of IC 2 [1–8] 2 [1–61] 0.25 aTotal dose >20 mg/d or >2 mg/kg/d of prednisone equivalent for ≥2 weeks preceding IC. b Pneumonia (n = 3), endocarditis (n = 1), esophagitis (n = 1). Disclosures All authors: No reported disclosures.