Time-to-Positivity for Candida in Bloodstream Infections: Prognostic Implications for Mortality

Background Candida-associated catheter-related bloodstream infections (CRBSIs) present a significant challenge in clinical settings, particularly among patients with central venous catheters (CVCs). Time-to-positivity (TTP) of blood cultures, an indicator of fungal load, may provide insights into infection prognosis and severity. This study evaluates the role of TTP in Candida-associated bloodstream infections and its impact on patient outcomes. Materials and methods This cross-sectional observational study, conducted from July 2023 to June 2024 at Saveetha Medical College, involved collecting blood cultures from intensive care unit (ICU) patients with suspected candidemia. Blood cultures were processed using the BacT/ALERT 3D system (bioMérieux, Marcy l'Étoile, France), with TTP recorded for each Candida-positive culture. Species identification was performed using MALDI-TOF MS (Bruker Daltonics, Germany). Species-specific 30-day mortality was analyzed to assess the impact of TTP on survival. Results Of 7447 blood cultures from ICU patients, 2349 were positive, with a 2.42% prevalence of Candida sp. Among 57 candidemia patients, the median TTP for deceased patients was 24 hours, compared to 25 hours for survivors (p=0.001). C. auris exhibited the highest mortality rate (56.25%) with a median TTP of 16.5 hours, whereas C. albicans had no associated mortality and a median TTP of 28.5 hours. Shorter TTP was consistently associated with higher mortality across Candida species. Conclusion This study highlights the prognostic value of TTP in Candida-associated bloodstream infections, with shorter TTP correlating with higher mortality. The findings underscore the need for rapid diagnosis and aggressive treatment, particularly for high-risk species like C. auris and C. glabrata. Further research is needed to refine the clinical application of TTP and develop targeted treatment strategies.