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. 2023 Apr 3;61(4):myad028.
doi: 10.1093/mmy/myad028.

Time-to-positivity in bloodstream infection for Candida species as a prognostic marker for mortality

Caitlin Keighley  1   2   3 , Alun L Pope  4   5 , Debbie Marriott  6 , Sharon C-A Chen  1   2 , Monica A Slavin  7 ; Australia and New Zealand Mycoses Interest Group
Collaborators, Affiliations

Time-to-positivity in bloodstream infection for Candida species as a prognostic marker for mortality

Caitlin Keighley et al. Med Mycol. .

Abstract

Time-to-positivity (TTP) may assist in predicting the outcome of candidaemia. We analysed a candidaemia dataset collected prospectively in Australia over 1 year (2014-2015). TTP was defined as the period from blood culture sampling to the blood culture flagging positive. Of 415 candidaemia episodes, overall, 30-day mortality was 29% (120/415); mortality with Candida albicans was 35% (59/169), C. glabrata complex, 37% (43/115), C. tropicalis, 43% (10/23), Pichia kudriavzevii 25% (3/12), and C. parapsilosis complex 7% (5/71). Each day of increased TTP multiplied the odds ratio (OR) of survival at 30 days by a factor of 1.32 [95% confidence interval (CI) 1.06-1.69]. Shorter TTP was associated with increased mortality, with 1-day TTP associated with 30-day mortality 37% (41/112) (95%CI: 28%-46%) and 5-day TTP 11% (2/18) (95%CI: 2%-36%).

Keywords: candidaemia; bloodstream infection; candida; mortality; time to positivity.

Plain language summary

Time-to-positivity is a measure that is available to clinicians when patients are identified as having candida in their bloodstream. Our data support the association of a shorter time to positivity with higher mortality.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curve estimates by TTP and Candida species. Vertical axis is survival probability and horizontal axis is number of days survived (censored at 30 days). In the legend, entries are ordered by survival probability at 30 days, ‘Days’ refers to TTP in days, and ‘Species’ is coded as follows: CP, Candida parapsilosis complex; PK, Pichia kudriavzevii; CA, Candida albicans; CG, Candida glabrata complex; CT, Candida tropicalis.
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