1694. Predictors of Septic Shock in Adult Patients with Candidemia: A Single-Center Experience Over 13 Years

Background Although the incidence of candidemia has been increased recently, factors associated with septic shock in adult patients with candidemia have not been well defined. We performed a study to identify septic shock risk factors. Methods This retrospective study was conducted among adult patients ≥19 years of age with candidemia who were diagnosed from 2006 to 2018 at a single tertiary care medical center. Clinical data were collected. Patients were excluded if they were noted to have concomitant bacteremia or to have received antifungal treatment <5 days. Results After application of the exclusion criteria, 46 patients (25.1%) were classified as having septic shock presentation out of 183 patients. Between the septic shock and non-septic shock patients, there were no differences regarding comorbidities. Variables associated with septic shock in the univariate analysis were non-remission of candidemia [23/46 (67.6%) vs. 100/137 (83.3%) P = 0.044], central venous catheter [41/46 (89.1%) vs. 98/137 (67.9) P = 0.005], hemodialysis [12/46 (26.1%) vs. 15/137 (10.9%) P = 0.012], neutropenia [10/46 (21.7%) vs. 14/137 (10.2%) P = 0.045], and previous hospitalization to the intensive care unit (ICU) [24/46 (52.2%) vs. 47/137 (34.3%) P = 0.031]. The group of other Candida species consisting of [C. guilliermondii, C. haemulonii, C. famata, C. lusitaniae, and unknown] was more common in the septic shock patients (10.9%) than in the non-septic shock patients (1.5%), P = 0.004. The mortality of patients with septic shock was significantly higher than that of patients without septic shock [37/46 (80.4%) vs. 59/137 (43.1%) P < 0.001]. Multivariate analysis showed central venous catheter (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.12 – 14.30, P = 0.033) and abnormal aspartate aminotransferase [AST] (OR 2.76, 95% CI 1.06 – 7.16, P = 0.024) were significantly associated with septic shock. Presence of other Candida species (OR 6.78, 95% CI 0.87 – 53.03, P = 0.068) showed borderline significance. Conclusion Our findings suggest that venous catheter and abnormal AST were significant factors associated with septic shock in adult patients with candidemia. Also, candidemia caused by other Candida species may need to be monitored closely for the development of septic shock presentation. Disclosures All authors: No reported disclosures.

Targeting avoidance via compound extinction

Avoidance towards innocuous cues is a key diagnostic criterion across anxiety-related disorders. Importantly, the most effective intervention for anxiety-related disorders, exposure therapy with response prevention, sometimes does not prevent the relapse of anxiety’s symptomatology. We tested whether extinction effects, the experimental proxy of exposure, are enhanced by increasing the discrepancy between the predic- tion of an unpleasant event happening (shock presentation), and the actual event (shock omission). Forty-eight individuals first saw pictures of three stimuli. Two pictures (CSA, CSB) were followed by a shock (US) and one (CS-) was not. Next, participants learned to avoid the US by pressing a computer key. An extinction and response prevention procedure followed. In the first part of it, participants saw unreinforced presentations of all CSs. In the second part, the single group saw un- reinforced presentations of the CSA and CS-. The compound group encountered compound unreinforced presentations of the CSA and CSB, and separate presenta- tions of the CS-. Return of avoidance and fear was tested after unsignalled presenta- tions of the US. Compound extinction resulted in comparable reduction of fear and avoidance compared to standard extinction. We discuss how future research could enhance extinction effects by adding costs to the avoidance behavior.