Persistent Candidemia in adults: underlying causes and clinical significance in the antifungal stewardship era
- 36 Downloads
To investigate the causes and the clinical significance of persistent candidemia (PC) in adults diagnosed in a tertiary hospital with an active antifungal stewardship program. Retrospective cohort including all adults with candidemia from 2010 to 2018. PC was defined as any positive follow-up blood culture (BC) obtained ≥ 5 days from the first BCs yielding the same Candida species. PC was detected in 35/255 (13.7%) patients. There were no differences regarding antifungal adequacy in PC vs. non-PC (94.3% vs. 82.3%, p = 0.084) and primary source control (63.3% vs. 76.4%, p = 0.172) at the time of the follow-up BCs. The average time until source control (2 [0–37] vs. 2 days [0–44], p = 0.311) or adequate antifungal treatment (2 [0–26] vs. 2 days [− 2–10], p = 0.748) was similar. Patients with PC had more non-ocular complications (31.4% vs. 10.5%, p = 0.002). No impact on 30-day mortality was observed (31.4% vs. 22.3%, p = 0.238). The only independent factor associated with PC was to have a previously undetected site of infection [OR 4.28, 95%CI (1.77–10.34), p = 0.001]. Persistent candidemia was not associated with inadequate or delayed therapeutic management, nor higher 30-day mortality rates. Timely screening and control of unexpected infection sources are encouraged to shorten hospitalization and improve patient care.
KeywordsPersistent candidemia Antifungal stewardship Mortality Candidemia
We would like to thank all participants of the COMIC Study Group (Collaborative Group on Mycoses): F. Anaya, R. Bañares, E. Bouza, A. Bustinza, E. Chamorro, P. Escribano, A.Fernández-Cruz, J. Fernández-Quero, I. Frias, J. Gayoso, P. Gijón, J. Guinea, J. Hortal, M. C. Martínez, I. Márquez, M. C. Menárguez, P. Muñoz, M. Navarro, B. Padilla, J. Palomo, T. Peláez, J. Peral, B. Pinilla, D. Rincón, C. G. Rodríguez, M. Rodríguez, M Salcedo, M.Sánchez-Somolinos, M. Sanjurjo, M. Valerio, E. Verde, and E. Zamora.
This study was supported by Fondo de Investigación Sanitaria (FIS) - PM (PI13/01148) and LJMZ (PI14/00740); CA was supported by CAPES Foundation, Brazil/PDSE (88881.187981/2018-01); PE (CPI15/00115) and JG (CPII15/00006) are recipients of a Miguel Servet grant, and AV (CM15/00181) was supported by a Rio Hortega grant from Instituto de Salud Carlos III (ISCIII), also co-financed by the European Regional Development Fund (FEDER) “A way of making Europe.” Additional funding was received through the Plan Nacional de I+D+I 2013-2016, and PROgrama MULtidisciplinar para la Gestión de Antifúngicos y la Reducción de Candidiasis Invasora (PROMULGA) II Project.
Compliance with ethical standards
This study was approved by the institutional ethics committee (Comité Ético de Investigación Clínica del Hospital Gregorio Marañón [CEIC-A1], study code MICRO.HGUGM.2015–071). The need for an informed consent was waived owing to the non-interventional, retrospective design of the study.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 7.Vena A, Munoz P, Corisco R, et al. Efficacy of a “check-list” intervention bundle on the clinical evolution of patients with Candida bloodstream infections. 27th ECCMID. 2017. p. 24–25Google Scholar
- 12.Pappas PG, Kauffman CA, Andes DR et al (2016) Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis Oxford Univ Press 62(4):e1–e50Google Scholar
- 13.Arendrup MC, Cuenca-Estrella M, Lass-Flörl C, Hope W (2012) EUCAST-AFST. EUCAST technical note on the EUCAST definitive document EDef 7.2: method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for yeasts EDef 7.2 (EUCAST-AFST)*. Clin Microbiol Infect 18(7):E246–E247CrossRefGoogle Scholar
- 22.Lin K-Y, Chen P-Y, Chuang Y-C et al (2018) Effectiveness of echinocandins versus fluconazole for treatment of persistent candidemia: a time-dependent analysis. J Inf Secur 77(3):242–248Google Scholar
- 26.Garnacho-Montero J, Diaz-Martin A, Garcia-Cabrera E, Ruiz Perez de Pipaon M, Hernandez-Caballero C, Lepe-Jimenez JA (2013) Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections. J Antimicrob Chemother 68(1):206–213CrossRefGoogle Scholar
- 28.Mahmood M, Kendi AT, Ajmal S, et al (2017) Meta-analysis of 18F-FDG PET/CT in the diagnosis of infective endocarditis. J Nucl Cardiol. Advance online publication. https://doi.org/10.1007/s12350-017-1092-8