Risk factors for persistent candidemia and prognostic implications: Results from the ECMM Candida III study.

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Mycology

Background:

• Candidemia poses a severe threat to critically ill and immunocompromised individuals, carrying high morbidity and mortality rates.
• Early eradication of Candida bloodstream infections may improve patient outcomes.
• The clinical significance of positive follow-up blood culture (FUBC) results in candidemia is not fully understood.

Purpose of the Study:

• To identify predictors of persistent candidemia.
• To evaluate the impact of positive FUBC results on clinical outcomes, including mortality.
• To analyze the association between adherence to treatment guidelines and persistent candidemia.

Main Methods:

• A sub-analysis of the multicenter ECMM Candida III study involving 258 adult patients with culture-proven candidemia.
• Statistical analysis using binary logistic regression to find predictors of persistent candidemia.
• Cox proportional hazards regression models were employed to assess mortality risk factors.

Main Results:

• Persistent candidemia occurred in 20.2% of patients, with a median duration of 6 days.
• Lower EQUAL Candida Scores, indicating poor guideline adherence (especially lack of initial echinocandin use), predicted persistent candidemia.
• Persistent candidemia lasting ≥5 days and intensive care unit (ICU) admission were independent predictors of mortality.

Conclusions:

• Poor adherence to treatment guidelines, reflected by low EQUAL Candida Scores, is associated with persistent candidemia.
• Persistent candidemia of ≥5 days duration is a significant independent predictor of mortality.
• Ensuring adherence to guidelines, including appropriate initial antifungal therapy, is critical for improving candidemia outcomes.