Recurrent candidemia reported in 6% of patients with prior infection
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Recurrent candidemia was reported in 6% of people with prior candidemia, with many patients reporting recent hospitalization, hepatitis C infection and being of younger age, according to a study published in Open Forum Infectious Diseases.
“Few studies have examined recurrent candidemia and many are restricted to only brief case reports. These previous studies have found that recurrent candidemia infections result in higher treatment failure and higher overall mortality, underscoring the need to better understand this patient population,” Emily N. Jenkins, MPH, Epidemiologist in the CDC’s Mycotic Diseases Branch, told Healio. “Our analysis used data from ongoing U.S. population-based surveillance to describe the frequency of and characteristics associated with recurrent candidemia that could guide prevention efforts.”
Jenkins and colleagues analyzed population-based candidemia surveillance data collected between 2011 and 2018 and compared factors during the initial episode between those who developed recurrent candidemia and those who did not.
Of the 5,428 people identified as having candidemia, 326 (6%) had recurrent infection, with more than one in every 20 patients having recurrence more than 30 days after initial infection.
In a multivariable logistic regression controlling for surveillance site and year, recurrent candidemia was associated with being 19 to 44 years old vs. 65 years and older (adjusted OR = 3.05; 95% CI, 2.1-4.44), being discharged to a private residence vs. a medical facility (aOR = 1.53; 95% CI, 1.12-2.08), hospitalization in the 90 days before the initial episode (aOR = 1.66; 95% CI, 1.27-2.18), receipt of total parenteral nutrition (aOR = 2.08; 95% CI, 1.58-2.73) and hepatitis C infection (aOR = 1.65; 95% CI, 1.12-2.43).
Jenkins said that the associations with younger age and hepatitis C suggest injection drug use may play a modifiable role.
“In the inpatient health care setting, prevention efforts targeting central venous catheter care and total parenteral nutrition use may help reduce recurrent candidemia and associated lengthy hospital stays and health care costs,” Jenkins said. “Clinicians should have heightened suspicion and a lower threshold for clinical assessment to test for candidemia among patients with persistent risk factors and a history of previous candidemia.”
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