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Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance
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Decoding candidemia in critically ill patients: unsupervised clustering identifies three unique phenotypes.

Florian Reizine1, Juliette Henry2, Luc Desmedt3

  • 1Service de Réanimation Polyvalente, Vannes Hospital Center, 56000, Vannes, France. florian.reizine@gmail.com.

Critical Care (London, England)
|June 27, 2026
PubMed
Summary

Three distinct clinical phenotypes of candidemia in critically ill patients were identified, each associated with significantly different 90-day mortality rates. Factors like cirrhosis and illness severity increased mortality risk, while catheter-related infections showed a protective effect.

Keywords:
CandidemiaClinical phenotypesIntensive careSepsisUnsupervised clustering

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Medical Informatics
  • Epidemiology

Background:

  • Candidemia presents diverse clinical characteristics in intensive care unit (ICU) patients.
  • Understanding these variations is crucial for predicting outcomes.

Purpose of the Study:

  • To identify distinct clinical phenotypes of candidemia in critically ill patients.
  • To evaluate the association between these phenotypes and 90-day mortality.

Main Methods:

  • Multicenter retrospective cohort study of 492 ICU patients with candidemia.
  • Factor analysis of mixed data (FAMD) and hierarchical clustering on principal components (HCPC) were used to define phenotypes.
  • Survival analysis employed Kaplan-Meier curves and Cox proportional hazards models.

Main Results:

  • Three distinct candidemia phenotypes were identified: Phenotype 1 (immunosuppressed/hematological malignancy), Phenotype 2 (elderly/cirrhotic/digestive source), and Phenotype 3 (younger/catheter-related).
  • 90-day mortality rates varied significantly across phenotypes (72.9%, 70.4%, and 50.3%, respectively).
  • Independent mortality predictors included age, cirrhosis, and severity scores (SAPS II); echinocandin use and catheter-related source were protective.

Conclusions:

  • Unsupervised clustering successfully delineated three clinically distinct candidemia phenotypes.
  • Patient demographics (age, cirrhosis) and illness severity are key determinants of mortality.
  • A catheter-related source of candidemia demonstrated a protective association with mortality.