Background Injection drug use (IDU) is a known, but infrequent risk factor on candidemia, however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. Methods Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. Results During 2017, 1191 candidemia cases were identified in patients over the age of 12 years (incidence: 6.9 per 100,000 population); 128 (10.7%) had IDU history and this proportion was especially high (34.6%) in patients with candidemia aged 19-44 years. Candidemia patients with IDU history were younger than those without (median age: 35 vs 63 years, p<0.001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%, Relative Risk (RR): 0.2; 95% Confidence Interval (CI): 0.1–0.5), abdominal surgery (3.9% vs 17.5%, RR: 0.2, CI: 0.09–0.5), and total parenteral nutrition (3.9% vs 22.5%, RR: 0.2, CI: 0.07–0.4). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%, RR: 3.7, CI: 3.1–4.4), those with hepatitis C (54.7% vs 6.4%, RR: 8.5, CI: 6.5–11.3), and in people who were homeless (13.3% vs 0.8%, RR: 15.7; CI: 7.1–34.5). Conclusion Clinicians should consider screening for candidemia in people who inject drugs and IDU in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19-44 years, and have community-associated candidemia.

The HRPO is the Institutional Review Board (IRB) ethics committee for research with human subjects at UNM. All participants provided signed informed consent. Declaration of Conflicting Interests We wish to draw the attention of the Editor to the following fact that may be considered as a potential conflict of interest regarding this manuscript. We note that Jackie Perez works for the Hopkins Center, and previously worked for the Center under its previous name, St. Joseph Center for Children and Families. Tamara Thiedeman previously worked for the St. Joseph Center for Children and Families. Perez is currently the Director of the Center and Thiedeman was it's previous Director. Both are licensed mental health professionals and they provide/provided services to clients, including some of the women who participated in this study. Both were involved in establishing the Women's Social Isolation Support Group discussed here and both participated in the research. However, we believe that this relationship did not interfere with their ability to carry out the research, as they were interested in an objective analysis of the dynamics of the group process as part of an assessment of the services they provide.

BackgroundCandidemia is a common healthcare-associated bloodstream infection associated with high morbidity and mortality. No current estimates exist for understanding its burden in the United States.MethodsIn 2017, CDC’s Emerging Infections Program (EIP) performed laboratory- and active population-based candidemia surveillance in 45 counties in nine states (California, Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee), encompassing ~17 million persons. A case was defined as Candida species isolated from blood in a surveillance area resident. EIP site staff reviewed medical records to collect demographic and clinical data. Using 2016 US census data, we created weighted estimates of national and regional incidence rates and mortality in persons with candidemia (defined as death from any cause within 7 days of incident candidemia).ResultsA total of 1,226 candidemia cases were identified in 2017. We estimated 23,000 candidemia cases (95% CI 20,000–25,000) occurred in the United States in 2017. Overall estimated incidence was 7.0/100,000 persons, with elevated rates in adults ≥65 years (20.3/100,000), males (8.0/100,000), and people of Black race (12.6/100,000) (table). Incidence was highest in the South Atlantic region (8.0/100,000) and lowest in the Pacific (6.0/100,000). Estimated number of deaths was 3,000 (1,000–5,000).ConclusionOur analysis highlights the substantial burden of candidemia in the US Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida species is likely higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions. Disclosures All authors: No reported disclosures.

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Background Accurate measurements for determining cardiac index can be obtained while patients are supine in bed at various backrest elevations. It is not clear if these measurements are accurate when patients are in a bedside chair. Objective To determine if cardiac index based on measurements obtained with the patient in a chair is similar to cardiac index based on measurements obtained with the patient in bed. Methods A convenience sample of cardiac surgical patients and a method-comparison design were used to compare cardiac index values based on measurements obtained with patients in 2 different positions: in a chair and in the bed. A standard thermodilution technique was used to measure cardiac output. Measurement of cardiac output in the second position was obtained immediately after measurement in the first position. Positions were randomly assigned. Bias and precision were calculated and graphed with the Bland-Altman method. Differences in cardiac index of 0.50 or more were considered clinically significant. Analysis of variance was used to determine differences between cardiac index values for the 2 positions. Results A total of 27 postoperative cardiac surgical patients were studied. Cardiac index values based on measurements obtained with patients in the 2 different positions did not differ significantly (F1,50 = 0.446; P = .51). The mean difference score (bias) between the 2 positions was −0.07 (precision, 0.30) Conclusions The practice of putting cardiac surgical patients whose hemodynamic status is stable back to bed before obtaining measurements for calculation of cardiac index may not be required for accurate values.