Persistent fungemia - Risk factors and outcome in 40 episodes

The aim of this multicenter survey was to assess risk factors and mortality in patients with persistent fungemia (PF). Cases of persistent fungemia, d efined as positive blood culture for at least 3 causative days of antifunga l therapy were selected. Forty cases of persistent fungemia (lasting more t han 3 days) were compared with 270 non-persistent fungemias appearing withi n the same period, and analyzed by univariate and multivariate analysis for risk factors and outcome. The median number of days of positive culture wa s 4.4 (3 - 20): 22 episodes were due to Candida albicans, 1 due to non-albi cans Candida spp., 6 episodes due to non-Candida spp. Yeasts: 15 were cathe ter related, 16 patients had yeast-infected surgical wounds, 12 were neutro penic, 4 cases were caused by species resistant in vitro, 2 to amphotericin B (Trichosporon spp.) and 2 to fluconazole (C. laurentii, C. glabrata). Fi fteen patients (37.5%) died, 7 of whom due to fungemia. Nineteen cases had one known risk factor (10 had infected wound, 4 infected vascular catheter, 3 were neutropenic and 2 had inappropriate therapy). Fourteen cases had tw o known risk factors (4 had wound and infected catheter, 4 neutropenia and infected catheter, 2 neutropenia and resistant organism, 4 other combinatio ns. Two cases had 3 known risk factors and one had 4 risk factors for persi stent fungemia. Artificial ventilation, C. glabrata etiology, non-Candida s pp. yeasts such as Trichosporon spp. and Cryptococcus spp. and prior surger y were significantly associated with persistent fungemia in univariate, whe reas only C. glabrata etiology in multivariate analysis. Breakthrough funge mia during empiric therapy with fluconazole was also observed more frequent ly in patients with persistent fungemia. However, there was no difference i n both attributable and overall mortality between both groups.