P-350. Epidemiology of <i>Candida auris</i> isolated from blood cultures at a tertiary care facility in metro Detroit

Abstract Background Candida auris is a serious global health threat and the number of cases has increased recently. C. auris is often resistant to commonly used antifungals, making it difficult to treat. The objective of this study is to describe the epidemiology of C. auris isolated from blood cultures at a tertiary care facility in metro Detroit. Methods All C. auris isolates from blood cultures at the Detroit Medical Center from 8/1/2019 to 4/25/2024 were reviewed. Patient characteristics as well as microbiological characteristics were evaluated. There are no established susceptibility breakpoints for C. auris but the CDC has published tentative MIC breakpoints (mcg/mL) based on closely related Candida species and expert opinion. Results Thirty-eight patients had a positive blood culture with C. auris. The median age was 66 years (IQR 60-72). Length of stay was 37 days (IQR 22-62) and length of stay prior to positive blood culture was 25 days (IQR 11-43). Twenty-one (55%) patients had a C. auris isolation flag in the electronic medical record (EMR) prior to the positive blood culture. Only 31 patients had susceptibility testing done. All 31 isolates that were tested were resistant to fluconazole (MIC ≥ 32 mcg/mL) and all were susceptible to micafungin (MIC ≤ 2 mcg/mL). Thirty of 31 (97%) isolates were also susceptible to amphotericin B (MIC ≤ 1 mcg/mL). The antifungals with no published breakpoints had the following median MICs: voriconazole 2 mcg/mL (IQR 1-4); itraconazole 1 mcg/mL (IQR 1-1); isavuconazole 2 mcg/mL (IQR 1-2); posaconazole 0.25 mcg/mL (IQR 0.25-0.5); caspofungin 0.25 mcg/mL (IQR 0.15-0.5); anidulafungin 1 mcg/mL (0.5-1). The distribution of MICs for each agents are shown in figure 2 and figure 3. Conclusion Data are lacking to determine the most appropriate therapy for C. auris but based on local epidemiology, the use of an echinocandin as a first-line option for C. auris infections is appropriate. Disclosures All Authors: No reported disclosures