Risk factors for persistent candidemia and prognostic implications: Results from the ECMM Candida III study

Year: 2025

Type: article

Abstract: OBJECTIVES: Candidemia is a severe complication in critically ill and immunocompromised patients, and is associated with high morbidity and mortality. While early fungal clearance may improve outcomes, the association between follow-up blood culture (FUBCs) results and clinical outcomes remains insufficiently explored. This sub-analysis of the ECMM Candida III study investigates predictors of persistent candidemia and the impact of positive FUBC results on clinical outcomes. METHODS: The multicenter ECMM Candida III study enrolled adults with culture-proven candidemia from 60 European centers (2018-2019). This sub-analysis included patients with at least one FUBC result reported (n = 258; 40.8%). Statistical analysis used SPSS 29 and R. Binary logistic regression was used to identify predictors of persistent candidemia. To assess mortality risk factors, Cox proportional hazards regression models were constructed. RESULTS: Of 258 patients, 52 (20.2%) had persistent candidemia based on positive FUBCs (median duration of candidemia 6 days). Utilization of echinocandins as first line treatment was less frequent (61.5% vs. 78.2%; p=0.014) in those with positive FUBCs. Mortality was significantly higher in the FUBC-positive group (50% vs. 32%; p=0.016). In the multivariable logistic regression model, lower EQUAL Candida Scores, reflecting reduced adherence to guideline-recommended management, were independently associated with persistent candidemia (OR 0.003, 95% CI 0.0002-0.07; p<0.001). Univariable Cox regression identified persistent candidemia ≥5 days (HR 2.16; 95% CI 1.33-3.53; p= 0.002) as a significant predictor of mortality. In the multivariable Cox regression model, intensive care unit (ICU) admission (HR 1.59, 95% CI 1.02-2.50; p= 0.039) and persistent candidemia ≥5 days (HR 2.06, 95% CI 1.26-3.37; p= 0.004) remained independent predictors of mortality. CONCLUSION: Persistent candidemia was predicted by poor adherence to treatment guidelines, as shown by low EQUAL Candida Scores, particularly due to the lack of initial echinocandin use. After controlling immortal time bias, persistent candidemia ≥5 days and ICU admission remained independent predictors of mortality in the multivariable model.

Source: Journal of Infection

DOI: 10.1016/j.jinf.2025.106629

Institutions: Medical University of Graz, University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University Hospital Cologne, Ospedale Policlinico San Martino, University of Genoa, Karolinska University Hospital, Karolinska Institutet, Hacettepe University, Inserm, Institut de Recherche en Santé, Environnement et Travail, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Université de Rennes, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, Centro de Investigación Biomédica en Red Enfermedades Infecciosas, University of Belgrade, Univerzitetski Klinički Centar Srbije, Manchester Academic Health Science Centre, University of Manchester, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Amsterdam University Medical Centers, Belfast Health and Social Care Trust, Hôpital Necker-Enfants Malades, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Radboud University Nijmegen, Radboud University Medical Center, Canisius-Wilhelmina Ziekenhuis, University of Basel, University Hospital of Basel, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, North-Western State Medical University named after I.I. Mechnikov, Public Health Wales, Cardiff University, Bursa Uludağ Üni̇versi̇tesi̇, University Hospitals of Leicester NHS Trust, Hospital Universitario Virgen del Rocío, Hospital Universitario La Paz, Ege University, Centre Hospitalier de Versailles, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, BioTechMed-Graz, Statens Serum Institut, University of Copenhagen, Rigshospitalet, German Center for Infection Research

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,030

Funders: Pfizer, AstraZeneca, Sanofi, Gilead Sciences, Medpace, Royal College of Pathologists of Australasia, Deutsches Zentrum für Infektionsforschung, HELIOS Kliniken, Cidara Therapeutics, Jazz Pharmaceuticals, Joint Programming Initiative on Antimicrobial Resistance, Moderna, National Institute for Health and Care Research, European Commission, Deutsche Forschungsgemeinschaft, European Society of Clinical Microbiology and Infectious Diseases, Bundesministerium für Bildung und Forschung, Novo Nordisk, Astellas Pharma, Shionogi, Ludwig-Maximilians-Universität München, Karl-Franzens-Universität Graz, Medizinische Universität Graz, Swedish Orphan Biovitrum, PharmaMar, Ipsen, Nordic Pharma Group, Idorsia Pharmaceuticals, Seqirus, Mundipharma Research Limited, Manchester Biomedical Research Centre, Sanofi-Aventis Deutschland, Agència de Gestió d'Ajuts Universitaris i de Recerca, Instituto de Salud Carlos III, Cilag

Awards: G1277151371, G1483213741, G1798610363, G4639651104, Personalización del tratamiento antibiótico empírico de la neutropenia febril en los pacientes hematológicos, G63337611, G6740555331, G7419645933, G8253907495

OpenAlex ID: W4415225119