Risk factors for late recurrent candidaemia. A retrospective matched case–control study
Identificadores
URI: http://hdl.handle.net/20.500.12020/1215ISSN: 1198-743X
DOI: 10.1016/j.cmi.2015.10.023
Autor/es
Muñoz, Patricia; Vena, Antonio; Valerio, Maricela; Álvarez-Uría, Ana; Guinea, Jesús; [et al.]Fecha
2015-11-05Tipo de documento
articleÁrea/s de conocimiento
Ciencias BiomédicasMateria/s Unesco
2414 MicrobiologíaResumen
Incidence, risk factors and clinical significance of late recurrent (LR) candidaemia (>1 month between episodes) remains unclear. The 1219
episodes of candidaemia detected from January 1985 to December 2014 were reviewed. We selected all cases with more than one episode
separated by at least 30 days after clinical resolution in the interim (cases) and compared each of them with two controls (patients with single
episodes of candidaemia). Clinical strains were genotyped to differentiate relapses from re-infection. Eighteen patients (1.48%) had 36
episodes of LR candidaemia (median 4 months). Independent risk factors for recurrence in the multivariate analysis were: underlying
gastrointestinal disease (OR 67.16; 95% CI 5.23–861.71; p 0.001) and fungaemia due to Candida parapsilosis (OR 9.10; 95% 1.33–62.00; p
0.02). All episodes of LR candidaemia diagnosed during the first 3 months were due to an intravascular source of infection, whereas in
those occurring after 3 months the main source of the disease was the abdomen, followed by endocarditis, and urinary tract. Molecular
typing showed that 42.9% of LR candidaemias were relapses and 57.1% were re-infections. Neither time of recurrence nor clinical origin
could predict type of recurrence. LR candidaemia is a relatively rare event that is more frequent in patients who have an initial episode
of candidaemia due to C. parapsilosis or an underlying gastrointestinal disease. Episodes of LR candidaemia that occur within the first 3
months should prompt an attempt to exclude an intravascular source of infection, whereas those occurring later point to an intraabdominal
origin.