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Sequential Time to Positivity as a Prognostic Indicator in Persistent Candidemia
Marta Albanell-Fernández1,2,3,4, Andrea Vergara4,5,6,7, Marta Bodro3,4,7,8
1Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Background:
Persistent candidemia is associated with increased mortality, yet prognostic markers beyond initial blood culture time to positivity (TTP) remain poorly defined. While the TTP ratio between follow-up blood cultures (FUBCs) has shown prognostic utility in persistent Staphylococcus aureus bacteremia, its role in persistent candidemia has not been established. We aimed to evaluate the impact of changes in TTP across serial blood cultures in people with candidemia persisting for ≥48 hours and to assess their association with clinical outcomes.
Methods:
Single-center retrospective study including adult patients with candidemia and persistently positive FUBC ≥48 hours despite active antifungal therapy. Time to positivity and TTP ratio were analyzed according to clinical, microbiological, and outcome variables. The association with 30-day mortality was assessed using multivariable logistic regression.
Results:
Among 544 people with candidemia, 69 with persistent candidemia were included. The median TTP ratio was 1.4 (1.1-2.3). Patients with a shorter TTP ratio (<1.4) had numerically higher 30-day mortality, 7-day mortality, and in-hospital mortality, but in no cases was this statistically significant. The duration of antifungal exposure was not correlated with TTP prolongation. Thirty-day mortality was 36.2% and was associated in the multivariate model with septic shock, while catheter-related infection was protective.
Conclusions:
Overall mortality was numerically higher among those with shorter prolongation of FUBC TTP, although a statistical difference was not reached. No significant TTP prolongation was observed in sequential blood cultures despite active antifungal therapy. Further studies are needed to optimize therapeutic strategies against tolerant and persistent Candida strains.
Main Points:
In people with persistent candidemia, a lower time-to-positivity (TTP) ratio (<1.4) had numerically higher mortality but was not statistically significant, likely due to the low number of events. Thirty-day mortality was associated in the multivariate model with septic shock, while catheter-related infection was protective. Duration of antifungal treatment was not associated with TTP prolongation. Further studies are needed to optimize management of persistent Candida strains.
