Time-to-positivity in bloodstream infection for <i>Candida</i> species as a prognostic marker for mortality
Caitlin Keighley, A. L. Pope, Debbie Marriott, Sharon C.‐A. Chen, Monica A. Slavin, Australia and New Zealand Mycoses Interest Group, Ian Arthur, Robert Baird, Narin Bak, Christopher C. Blyth, Jeannie Botes, Belinda Chapman, Elaine Cheong, Louise Cooley, Kathryn Daveson, Rob George, Emma Goeman, Krispin Hajkowicz, Catriona Halliday, Christopher H. Heath, Ann Hofmeyr, Pankaja Kalukottege, Alison Kesson, Karina Kennedy, Sarah Kidd, Tony M. Korman, Michael Leung, Eunice Liu, Nenad Maćešić, Kyle McDonald, Brendan McMullan, Orla Morrissey, Stella Pendle, Jenny Robson, Tania C. Sorrell, Neil Underwood, Sebastian van Hal, Kerry Weeks, Heather L. Wilson
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%).