P-1935. Persistent Candidemia: Predictors and Outcomes in a Multicenter Matched Analysis

TL;DR

This study compares patients with persistent candidemia to those without, finding higher mortality and distinct clinical features in persistent cases.

Contribution

A multicenter matched analysis identifies predictors and outcomes of persistent candidemia, revealing demographic, microbiological, and clinical differences.

Findings

Persistent candidemia cases had higher 90-day mortality (54.3%) compared to non-persistent cases (31.5%).

C. guilliermondii was over-represented in persistent candidemia cases.

Persistent candidemia was associated with younger age, female sex, and higher comorbidity scores.

Abstract

Persistent candidemia (PC) occurs in a minority of Candida bloodstream infections (BSIs) but is associated with increased morbidity. Comparative data on patient profile, species distribution and outcomes are limited.Table 1Clinical profile and outcomes of patients with persistent candidemia in the primary study cohort. ANC = absolute neutrophil count. SD = standard deviation.Table 2Comparative analysis of persistent candidemia and non-persistent candidemia cases.

Clinical profile and outcomes of patients with persistent candidemia in the primary study cohort. ANC = absolute neutrophil count. SD = standard deviation.

Comparative analysis of persistent candidemia and non-persistent candidemia cases.

All candidemia episodes at three academic medical centers (2018-2025) were reviewed. Persistence was defined as ≥72 hours of positive blood cultures after appropriate antifungal initiation. Each PC case was matched 1:2 to non-PC controls who survived ≥72 hours. Demographics, Charlson Comorbidity Index (CCI), Candida species distribution, and outcomes were used for comparative analysis. Continuous variables were summarized as median (interquartile range [IQR]) and compared with Wilcoxon rank-sum, while categorical data (n%) were analyzed by Fisher’s exact test (species by χ²), yielding odds ratios (ORs) with 95% confidence intervals (CIs). Two-tailed p < 0.05 denoted significance.

Each PC case (n = 46) was matched 1:2 to non-PC controls (n = 92). Clinical profiles and outcomes of PC cases are presented in Table 1. Most PC patients (54.3%) had an immunocompromising condition, and non-urinary intra-abdominal sources were the most frequently suspected infection source (21/46; 45.7%). All but one of 46 PC cases had antibiotic exposure within the preceding 90 days. Comparative demographics and outcomes for PC cases and non-PC controls are displayed in Table 2. PC patients were younger (median 62 yr, IQR 45–69 vs 68 yr, 57–76; p = 0.01), more often female (59% vs 30%; OR 3.3, 95% CI 1.5–7.1; p = 0.002), and had higher comorbidity (CCI 5, IQR 3–8 vs 3, 1–4; p < 0.001). Species distribution differed (χ² p = 0.04), driven by C. guilliermondii over-representation in PC cases (9% vs 0%) (Figures 1 and 2). Hospital stay was longer in PC cases (median 36 d, 24–54 vs 16 d, 8–28; p < 0.001) and time from admission to first culture greater (12 d, 3–26 vs 3 d, 1–10; p = 0.003). 90-day mortality was 54.3% (25/46) in PC cases versus 31.5% (29/92) in controls (OR 2.57, 95% CI 1.17–5.71; p = 0.016).

In this 7-year multicenter study, there were significant differences in demographics, microbiology, and clinical outcomes between PC and non-PC cases, including higher short-term mortality rates with PC in univariate analysis.

Paschalis Vergidis, MD, MSc, Current Fungal Infection Reports: Honoraria|F2G: Grant/Research Support|Merck Manuals: Honoraria|Mundipharma: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support

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