Sequential time to positivity as a prognostic indicator in persistent candidemia
Marta Albanell-Fernández, Andrea Vergara, Marta Bodro, Mateu Espasa, Paula Juan, Josep Mensa, Montse Tuset, Sabina Herrera, Álex SorianoAbstract
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 (FUBC) 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 patients 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 h despite active antifungal therapy. TTP and TTP ratio were analysed according to clinical, microbiological, and outcome variables. The association with 30-day mortality was assessed using multivariable logistic regression.
Results
Among 544 patients 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.