Characteristics of late recurrent candidemia in adult patients.

BACKGROUND AND OBJECTIVES: Candida species are one of the most common causes of health care-associated bloodstream infections. However, recurrent candidemia is rare, and the characteristics of late recurrent (LR) candidemia are partly unclear. Our aim was to evaluate the characteristics of LR candidemia in adult patients. PATIENTS AND METHODS: A retrospective cohort study was performed in the hospital district of Helsinki and Uusimaa in Finland (2007-2016). All candidemia cases were searched in an electronic database during the study period. Patients with LR candidemia were compared with patients with a single candidemia episode to evaluate the characteristics of LR candidemia. LR candidemia was defined as having at least two episodes of candidemia more than 30 days apart. RESULTS: We identified 24 episodes of LR candidemia in 20 patients. Patients with LR candidemia represented 6% of all patients with candidemia during the study period, and most of these cases were nosocomial. The median time between the first and the recurrent episode was 5.1 months. One-year mortality in LR candidemia was 45%. Underlying gastrointestinal disease (OR 7.21, 95% CI 2.52-20.61) and history of intra-venous drug use (IVDU) (OR 3.62, 95% CI 1.03-12.69) were independent risk factors for LR candidemia in the multivariable analysis. CONCLUSION: Our study indicates that the gastrointestinal tract may be a continuous source of infection in patients with chronic gastrointestinal diseases. Gastrointestinal diseases and IVDU should be regarded as risk factors for LR candidemia.

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

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.

Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007-2016.

Background: Candidemia is a life-threatening infection with high mortality. Our aim was to evaluate the Candida species distribution, antifungal susceptibilities and risk factors associated with 30-day mortality in candidemia in Southern Finland. Methods: We present a retrospective analysis of candidemia cases from the hospital district of Helsinki and Uusimaa during 2007-2016. Patients younger than 18 years old were excluded. A total of 386 candida isolates from 374 episodes of candidemia were identified in 350 adult patients. Results:Candida albicans was the leading cause of candidemia (60.4%), followed by C. glabrata (21.5%), C. parapsilosis (5.2%) and C. dubliniensis (5.2%). There was no statistically significant change in the distribution of C. albicans vs non-albicans species during the study period. Thirty-day overall mortality was 30.7%. When patients who received no antifungal treatment were excluded from the mortality analysis, 30-day mortality was 23.0%. Severity of underlying illnesses (OR 20.55, 95% CI 5.98-70.60), ICU stay at the onset of candidemia (OR 5.06, 95% CI 1.75-14.68) and age >65 years (OR 3.98, 95% CI 1.97-8.02) were independent risk factors of 30-day mortality in multivariable analysis. However, there was no statistically significant association between 30-day mortality and an early start of an effective antifungal. Conclusion: There was not a significant shift to non-albicans species as the cause of candidemia in Southern Finland during the 10-year study period. Furthermore, we did not find an association between 30-day mortality and the early start of an antifungal treatment. Comorbidity considerably increased the risk of fatal outcome.