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Observational Study
. 2025 Sep;91(3):106586.
doi: 10.1016/j.jinf.2025.106586. Epub 2025 Aug 13.

Persistent candidemia caused by different Candida species: Data from a multicenter contemporary cohort

Giusy Tiseo  1 , Antonio Vena  2 , Matteo Bassetti  3 , Claudia Bartalucci  2 , Matteo Cerchiaro  2 , Mario Cesaretti  1 , Anna Marchese  4 , Vincenzo Di Pilato  4 , Pilar Escribano  5 , Arianna Forniti  1 , Daniele Roberto Giacobbe  2 , Jesus Guinea  5 , Alessandro Limongelli  2 , Antonella Lupetti  6 , Marina Machado  7 , Malgorzata Mikulska  2 , Jon Salmanton-García  8 , Ana Soriano-Martin  7 , Lucia Taramasso  2 , Maricela Valerio  9 , Emilio Bouza  9 , Patricia Muñoz  9 , Marco Falcone  1 ; ESCMID Fungal Infection Study Group (EFISG)
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Free article
Observational Study

Persistent candidemia caused by different Candida species: Data from a multicenter contemporary cohort

Giusy Tiseo et al. J Infect. 2025 Sep.
Free article

Abstract

Objectives: To explore persistent candidemia by different Candida spp.

Methods: Observational, retrospective, multicenter study including patients with candidemia (Jan 2018-Dec 2022) from 3 hospitals in Italy and Spain. The primary outcome was persistent candidemia, defined as positive blood culture (BC) yielding the same Candida spp≥5 days from the start of active antifungals. Patients with no available follow-up BCs were excluded. A competing risk analysis (competing risk of death) was performed using Fine and Gray regression models.

Results: Among 1188 patients, 298 (25.1%) had persistent candidemia. Cancer (sHR 1.335, 95% CI 1.037-1.633, p=0.011), total parenteral nutrition (sHR 1.440, 95%CI 1.062-1.818, p=0.006), Candida parapsilosis (sHR 1.312, 95% CI 1.075-1.633, p=0.03) and Candida auris (sHR 1.549, 95% CI 1.155-2.159, p=0.029) compared to Candida albicans, were associated with increased risk of persistent candidemia, whereas primary candidemia (sHR 0.573, 95% CI 0.321-0.825, p<0.001) and early source control (sHR 0.557, 95% CI 0.401-0.713, p<0.001) were protective. Persistent candidemia was associated with higher 30-day mortality (aHR 1.605, 95% CI 1.176-2.191, p=0.003).

Conclusions: Persistent candidemia affects one in four patients with Candida BSI. Infections caused by Candida parapsilosis or Candida auris require individualized management, with early source control being essential to reduce the risk of persistence.

Keywords: C. auris; C. parapsilosis; Candida; Candidemia; Persistent candidemia.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Outside the submitted work, GT declares personal fees for speaker/advisor from Shionogi, Menarini, MSD, Gilead, Angelini. Outside the submitted work, AV reports personal fees for speaker/advisor from Pfizer Inc, Shionogi, Tillotts Pharma, Menarini, Gilead Italia, Merck. Outside the submitted work, DRG reports investigator-initiated grants from Pfizer Inc, Shionogi, BioMérieux, Tillotts Pharma, Menarini, and Gilead Italia, personal fees for speaker/advisor from Pfizer, Menarini, BioMérieux, and Tillotts Pharma. Outside the submitted work, MB reports research grants and/or personal fees for advisor/consultant and/or speaker/ chairman from Bayer, BioMérieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, and Shionogi. JSG has received speaker honoraria by Gilead, Menarini, and Pfizer; travel grant by AstraZeneca and has been advisory board for Pfizer, outside of the submitted work. Outside the submitted work, PM reports investigator-initiated grants from Pfizer Inc, Shionogi, Tillotts Pharma, Menarini, and Gilead. Outside the submitted work, VDP reports payments for participation in a company sponsored speaker’s bureau from A.d.a, consulting fee from Biorad, supports for attending meetings from Arrow Diagnostics. Outside the submitted work, MF declares unconditional grants from MSD and grants/or speaker honoraria from Angelini, Shionogi, Pfizer, Menarini, Gilead and Nordic Pharma. The other authors report no conflicts of interest relevant to this paper.

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