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

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 5days 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. 2days [0-44], p=0.311) or adequate antifungal treatment (2 [0-26] vs. 2days [-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.