title: Risk factors for late recurrent candidaemia. A retrospective matched case-control study.
abstract: 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 intra-abdominal origin.
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón General Universitario, Madrid, Spain; CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: pmunoz@micro.hggm.es.
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón General Universitario, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: anton.vena@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Vena
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Álvarez-Uría
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Guinea
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Escribano
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón General Universitario, Madrid, Spain; CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification* / Q000235:genetics*; D058387:Candidemia; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D063868:Patient Outcome Assessment; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Candida endocarditis; candidaemia; candidiasis; invasive disease; recurrent infection