P-2268. <i>Candida tropicalis</i> Invasive Infection in Febrile Neutropenia, a High Mortality Infection

Abstract Background Invasive candidiasis due to species other than Candida albicans emerges as a problem in neutropenic patients receiving antifungal prophylaxis, due to decreased susceptibility to triazoles. Candida tropicalis is the most frequently species in this population and is associated with higher mortality when compared to Candida albicans. The aim of this study is to characterize the neutropenic population with invasive candidiasis and establish differences in outcome of patients with Candida tropicalis infection compared to other Candida species. Characteristics of patients with invasive candidiasis Methods Retrospective cohort study of patients with hematological malignancies undergoing chemotherapy who developed invasive candidiasis between 2010 and 2022. Comparison of two qualitative variables was performed using Pearson's Chi-square test or Fisher's exact test. Estimation of group survival was performed using the Kaplan-Meier method and comparison of survival functions with the Log-Rank test. Results of multivariate analysis of risk factors associated with adverse outcomes. Results At the time of fungemia, 85% of patients had active malignancy, with a median of 14 days of neutropenia until the development of infection. 15% of patients had mucositis and up to 60% had concomitant diarrhea. 95% had previously received antibiotics and 87.5% had a central catheter. In 40% of the patients, the infection occurred as a breakthrough infection and in 37.5% it was associated with azole resistance. 32.5% of cases were associated with deep-seated infection and 25% had persistent fungemia. The 30-day mortality of patients with candidemia due to C. tropicalis was higher than that experienced by subjects with candidemia due to other species (69% vs. 35%, p = 0.034). The median overall survival was 15 days (95% CI 12-18) for the first group. Multivariate analysis showed that C. tropicalis infection was associated with an increased risk of all-cause mortality. The risk factors associated with cutaneous lesions were C. tropicalis infection and azul resistance. Overall survival of study patients Conclusion Patients who develop C. tropicalis candidemia during febrile neutropenia after chemotherapy for hematologic malignancies have a higher mortality than those infected with other Candida species. Azole resistance emerges as a threat given routine prophylaxis in this population, so mitigation strategies are necessary. Disclosures All Authors: No reported disclosures