Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Abstract

Mycoses. 2020;63:617-624. | 617 wileyonlinelibrary.com/journal/myc | INTRODUC TI ONCandida is a major cause of nosocomial infections, 1 and candidaemia causes significant mortality ranging between 30% and 45%. [2][3][4][5] Furthermore, candidaemia generates significant healthcare costs. 2 Its main complications include metastatic infection foci and death. 6 Persistent candidaemia (PC) is frequently recognised as another complication of candidaemia. Underlying factors that can influence the persistence of blood culture positivity in candidaemia Summary Objectives: Persistent candidaemia (PC) is a recognised complication of candidaemia. Our objective was to evaluate risk factors and clinical significance of PC in adult patients.Methods: This is a retrospective, cohort study. We compared PC with non-PC. All patients with blood cultures positive for Candida species were identified from a microbiological database in the hospital district of Helsinki and Uusimaa from 2007 to 2016. PC was defined as an isolation of the same Candida species from positive blood culture for ≥5 days. Results: PC criteria were fulfilled by 75/350 patients (21.4%). No significant difference emerged between persistent and non-persistent cases caused by non-albicans Candida species (37.3% vs 35.1%, P = .742). The length of hospital stay before onset of candidaemia was longer before PC (hospital stay > 7 days; 73.3% vs 59.6%, P = .043).No significant impact on 30-day mortality was observed (20.0% vs 15.5%, P = .422).Using multivariable regression analysis, we found the presence of central venous catheter (CVC) (OR = 2.71, 95% CI 1.31-5.59), metastatic infection foci (OR 3.60, 95% CI 1.66-7.79) and ineffective empirical treatment (OR = 3.31, 95% CI 1.43-7.65) to be independent risk factors for PC. In subgroup analysis, early source control was identified as a protective factor against PC (30.5% vs 57.7%, P = .002). Conclusion:The presence of CVC, metastatic infection foci and ineffective empirical treatment were independently associated with PC in adult patients. Active search for and treatment of metastatic infection foci and removal of CVC are key elements for preventing PC. K E Y W O R D S adult patients, central venous catheter, metastatic infection foci, Persistent candidaemia

Use and outcome of empiric echinocandins in critically ill patients

“…Currently, it has been shown that ineffective empirical treatment was associated with persistent candidemia in adult patients. 31 There are reports showing an increase in infections caused by non-albicans species, [26][27][28] while in our series both Candida albicans and non-albicans species were found equally often only in deep-site cultures. Furthermore, in blood cultures and central line specimens, Candida albicans was still more prevalent.…”

“…However, four of six (67%) of non‐albicans species were resistant to fluconazole. Currently, it has been shown that ineffective empirical treatment was associated with persistent candidemia in adult patients 31 . There are reports showing an increase in infections caused by non ‐ albicans species, 26‐28 while in our series both Candida albicans and non‐albicans species were found equally often only in deep‐site cultures.…”

How Biofilm Growth Affects Candida-Host Interactions

“…However, even with catheter removal, mortality rates remain high in the setting of invasive candidiasis (Andes et al, 2012). The observation that removal of catheters decreases the risk of persistent candidemia and rate of mortality suggests that biofilm formation plays a major role in the pathogenesis of invasive candidiasis (Andes et al, 2012;Ala-Houhala and Anttila, 2020).…”

Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes

“…Although there have been multicenter studies that did not reach a conclusion on the importance of early CVC removal to the outcomes [ 31 , 32 , 33 ], we did find that delayed CVC removal in neonates with candidemia was independently associated with final in-hospital mortality. This can probably be explained by these patients being more likely to have persistent candidemia and/or breakthrough candidemia, which is associated with final adverse outcomes [ 34 , 35 ]. However, in cases when the catheter is not the source of sepsis, it deserves a prospective, randomized controlled trial to document whether prompt catheter removal contributes significantly to the outcomes as it is often difficult to reinsert the CVC during the critically ill period.…”