P-347. Investigating Risk Factors for <i>Candida auris</i> Bloodstream Infections: A Case-Control Study from Los Angeles County

Abstract Background Candida auris (C. auris) has emerged as a significant pathogen due to its ability to cause bloodstream infections (BSIs) in highly vulnerable patient populations. Understanding the risk factors associated with C. auris BSIs is crucial for implementing targeted interventions to mitigate the burden of infection and ensure patient safety. In Los Angeles County (LAC), all C. auris cases are reportable to the Department of Public Health (DPH). Methods We conducted a case-control study to identify risk factors associated with C. auris BSIs. Using data reported to LAC from June 2019 to April 2024, cases included persons initially colonized with C. auris who subsequently developed confirmed C. auris BSI, while controls consisted of persons colonized with C. auris without C. auris identified from a clinical specimen site. C. auris cases and controls were identified via required laboratory and provider reporting of all positive C. auris tests. Data on various risk factors were collected from provider case reports that were completed on all C. auris-positive persons, excluding cases with missing risk factor data. We used logistic regression to estimate the adjusted odds ratios of a colonized case acquiring a C. auris BSI compared to only colonized persons, adjusting for age, sex, race/ethnicity, and healthcare facility where the positive specimen was collected. Results Of the 174 cases and 2,602 controls identified, increased odds of BSI were observed among patients with prior antifungal use (OR: 3.58, 95% CI: 1.12-11.41) and hemodialysis (OR: 2.33, 95% CI: 1.05-5.16). Other risk factors such as ventilator use, tracheostomy, central venous catheter presence, and wound presence showed no statistically significant associations. Conclusion Targeted infection prevention strategies are vital to mitigate C. auris BSI burden. Rigorous aseptic techniques during hemodialysis and judicious use of antifungal agents may reduce C. auris BSI risk. Although adjusted for in this analysis, specialized attention to infection control in healthcare facilities such as long-term acute care hospitals may be warranted, given their unique patient populations and care settings. Further investigation is warranted to identify additional strategies to mitigate C. auris BSI risk. Disclosures All Authors: No reported disclosures