Persistent Candidemia in adults: underlying causes and clinical significance in the antifungal stewardship era

Collection Location Koleksi E-book & E-Journal Perpustakaan Pusat Unila
Edition Vol. 38, Issue 3
Call Number
ISBN/ISSN 1435-4373
Author(s) Agnelli, Caroline...[et al.]
Subject(s) Biomedicine
Classification NONE
Series Title
GMD E-Journal
Language English
Publisher Springer
Publishing Year 2019
Publishing Place Switzerland
Abstract/Notes Abstract
To investigate the causes and the clinical significance of persistent candidemia (PC) in adults diagnosed in a tertiary hospital with
an active antifungal stewardship program. Retrospective cohort including all adults with candidemia from 2010 to 2018. PC was
defined as any positive follow-up blood culture (BC) obtained ≥ 5 days from the first BCs yielding the same Candida species. PC
was detected in 35/255 (13.7%) patients. There were no differences regarding antifungal adequacy in PC vs. non-PC (94.3% vs.
82.3%, p = 0.084) and primary source control (63.3% vs. 76.4%, p = 0.172) at the time of the follow-up BCs. The average time
until source control (2 [0–37] vs. 2 days [0–44], p = 0.311) or adequate antifungal treatment (2 [0–26] vs. 2 days [− 2–10], p =
0.748) was similar. Patients with PC had more non-ocular complications (31.4% vs. 10.5%, p = 0.002). No impact on 30-day
mortality was observed (31.4% vs. 22.3%, p = 0.238). The only independent factor associated with PC was to have a previously
undetected site of infection [OR 4.28, 95%CI (1.77–10.34), p = 0.001]. Persistent candidemia was not associated with inadequate
or delayed therapeutic management, nor higher 30-day mortality rates. Timely screening and control of unexpected infection
sources are encouraged to shorten hospitalization and improve patient care.
Keywords Persistent candidemia . Antifungal stewardship . Mortality . Candidemia
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