Mediterranean Journal of Infection, Microbes and Antimicrobials (Jul 2024)

Rare Conditions of Candidemia: Risk Factors and Outcomes for Mixed Candidemia and Late Recurrent Candidemia

  • Bahadır Orkun ÖZBAY,
  • Aliye BAŞTUĞ,
  • Ömer AYDOS,
  • Nizamettin KEMİRTLEK,
  • Derya GÖKÇINAR,
  • Bedia DİNÇ,
  • Hürrem BODUR

DOI
https://doi.org/10.4274/mjima.galenos.2024.24180.10
Journal volume & issue
Vol. 13, no. 1

Abstract

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Introduction: Mixed candidemia (MC) and late recurrent candidemia (LRC) are rare conditions. Studies on these issues are limited. Our aim was to investigate the characteristics, risk factors, and outcomes of these rare conditions. Materials and Methods: The study was carried out between May 2019-May 2021 in Ankara City Hospital as a cross-sectional descriptive study. Mixed candidemia was defined as the isolation of at least two Candida species in two blood culture bottles taken within 72 hours or one blood culture bottle taken simultaneously (from a patient with clinical symptoms). Late recurrent candidemia was defined as the recurrence of candidemia at least 30 days after the treatment of the first candidemia episode was completed and the symptoms resolved. In the study, MC patients were compared with monomicrobial candidemia patients. The LRC group was compared with the single episode candidemia group. Results: During the study period, 549 candidemia episodes were detected in 533 patients. Mixed candidemia was detected in 38 (7.1%) of these patients. Late recurrent candidemia was seen in 16 (10.7%) of 149 patients who recovered after treatment and survived above 30 days. History of abdominal surgery and instrumentation, chemotherapy and transplantation were significantly higher in the MC group compared to the monomicrobial candidemia group. Compared to the single episode candidemia, the LRC group had significantly higher rate of abdominal surgery and instrumentation history, concomitant bacteremia, Candida colonization index of >0.5 and 1-year follow-up mortality. Conclusion: Both MC and LRC were significantly more common in patients who had undergone abdominal surgery and instrumentation. With the development of diagnostic methods, we may encounter these rare cases more often. Since candidemia has a high mortality rate, recurrent candidemia may be overlooked. According to the results of the study, there is a 10% risk of recurrence in recovered candidemia cases.

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