Persistent Candidemia: Causes and Investigations

Abstract

Persistent candidemia refers to the continued isolation of the same Candida species in the blood of a candidemic patient. Its incidence and clinical consequences are not well understood because of the lack of a homogeneous definition for persistent candidemia and the absence of prospective studies in which blood cultures were performed at prespecified times. Data from randomized clinical trials indicate that between 8% and 15% of candidemic patients have persistently positive blood cultures at the end of treatment, and the few studies that have attempted to evaluate the impact of persistent candidemia on outcomes have lacked appropriate analysis to conclude whether persistent candidemia is associated with worse outcome. On the other hand, assuming that it represents therapeutic failure, major causes for persistent candidemia include host factors (probably the most important), drug resistance, low serum levels of drugs, endovascular infection, deep-tissue abscesses, and infection associated with prosthetic material.