Abstract
Persistent candidaemia (PC) is a recognised complication of candidaemia. Our objective was to evaluate risk factors and clinical significance of PC in adult patients. 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 ≥5days. 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>7days; 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). 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.
Highlights
Candida is a major cause of nosocomial infections,[1] and candidaemia causes significant mortality ranging between 30% and 45%
Persistent candidaemia (PC) was defined as an isolation of the same Candida species from any positive blood culture taken ≥5 days after the first positive blood samples were drawn
Using multivariable regression analysis (Table 4), we found the presence of central venous catheter (CVC) (OR = 2.71; 95% confidence interval (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
Summary
Candida is a major cause of nosocomial infections,[1] and candidaemia causes significant mortality ranging between 30% and 45%.2-5 candidaemia generates significant healthcare costs.[2]. Candida is a major cause of nosocomial infections,[1] and candidaemia causes significant mortality ranging between 30% and 45%.2-5. Candidaemia generates significant healthcare costs.[2] Its main complications include metastatic infection foci and death.[6]. The most relevant problem in evaluating PC is the lack of a homogeneous definition of PC.[7] Most studies evaluating PC include adult and child populations or have been conducted only in neonatal populations.[2,8,9,10,11] This complicates any generalisation of the results to adult patients. The definition of PC ranges from >1 day to 7 days in literature, which influences PC incidence rates.[7] The reported incidence rates of PC vary from 8% to 93%.7. The reported incidence rates of PC vary from 8% to 93%.7 the reported rates are at 11%-37% when considering only studies with a definition of candidaemia duration of 3-5 days.[12,13,14,15] several studies have evaluated PC, the data are mostly from research designed to consider other elements than PC.[16,17,18]
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