Clinical manifestations and molecular epidemiology of late recurrent candidemia, and implications for management

The: aim of this study was to define the epidemiology and clinical manifest ations of late recurrent candidemia. For this purpose, late recurrent candi demia was defined as atl episode of candidemia occurring at least 1 month a fter the apparent complete resolution of an infectious episode caused by th e same Candida sp. A total of five patients with recurrent candidemia were investigated. For all patients, isolates from the initial and recurrent epi sodes of candidemia were available for in vitro susceptibility testing and genetic characterization by DNA-based techniques. The results revealed the following salient features. prolonged duration between the initial and recu rrent episodes (range, 1-8 months); recurrence of candidemia despite antifu ngal therapy; importance of retained intravascular catheters, neutropenia, and corticosteroids as factors predisposing to recurrence; high morbidity a nd mortality; no emergence of antifungal drug resistance between the initia l and recurrent episodes; and relapse of infection due to the original infe cting strain, rather than reinfection with a new strain. These findings rai se several issues about the management and follow-up of patients with candi demia, which require assessment in future studies.