Clinical Profile and Outcomes of Persistent Candidemia: A Matched Case-Control Study

Although candidemia is among the most common invasive fungal infections in hospitalized patients, the persistence of bloodstream infection despite antifungal therapy remains poorly characterized. We performed a retrospective, matched case-control study of persistent candidemia (PC) across three tertiary care centers in the United States over a seven-year period (2018-2025). PC was defined as at least 72 hours of positive blood cultures with the same Candida species from the start of active antifungal therapy. Cases were matched 1:2 to controls with non-persistent candidemia by diagnosis date. Associations were evaluated using conditional logistic regression within matched strata. The cohort included 47 PC cases and 94 matched controls. Compared with controls, cases were more likely to have a central venous catheter (CVC) at candidemia onset and be in the intensive care unit at diagnosis. Intra-abdominal sources were more common with PC. In multivariable analyses, CVC presence (adjusted odds ratio (aOR) 4.58, 95% CI 1.39-15.09) and ICU status (aOR 3.10, 95% CI 1.10-8.72) were associated with persistence, while male sex was inversely associated (aOR 0.21, 95% CI 0.08-0.60; P = 0.004). PC was associated with longer duration of hospitalization (median 36 vs 19 days; P < 0.001) and higher 30-day all-cause mortality (40.4% vs 22.3%; P = 0.040). In summary, PC was associated with higher mortality and longer hospital stays than non-persistent candidemia. Central venous catheter presence and intensive care unit status were independently associated with persistence.