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We used molecular methods to compare the genotypes of sequential isolates, and the observation period was long (1062?patient-years). VE-821 order According to our data, late recurrent candidaemia is a relatively rare event, occurring in 4.4% of patients who survive the initial episode, but the incidence is close to ten-fold higher than in the general population. The median time between the first episode of candidaemia and the recurrence (or between recurrences) was 6?months, ranging from Parvulin blood culture that was positive for Candida. The median time between recurrences was 1?month, ranging from 1 to 8?months [13]. Other studies of recurrent candidaemia have reported an interval from 1 to 6?months [14�C17], whereas persistent Candida prosthetic valve endocarditis has been reported to occur up to 3?years following the initial infection [25]. These previous case series and case reports lack the population-based design and long-term follow-up provided by this study. Outbreaks or clusters of identical genotypes of Candida causing BSIs have previously been shown to have the ability to smoulder over a long period of time, even years [18]. The most common reason for recurrences in the current study was the persistence of particular risk factors for candidaemia among the patients, rather than relapses from inadequately treated infections. Many of the patients had chronic underlying diseases, such as diabetes, gastrointestinal diseases, or malignancy, requiring frequent antimicrobial and/or immunosuppressive therapy. Patients with recurrences did not differ from those with a single episode with regard to most risk factors or therapeutic measures (removal of central venous catheters and antifungal therapy). This contrasts with studies BEZ235 chemical structure reporting a high proportion of retained intravascular catheters among patients who developed persistent or recurrent candidaemia [13,21]. In our cohort, a significantly higher proportion of patients with recurrences had underlying gastrointestinal diseases, and a large proportion had previous abdominal surgery. Similarly, in the study by Clancy et?al. [13], two of the five patients with recurrent candidaemia had previous abdominal surgery and underlying gastrointestinal diseases. The gastrointestinal tract is an important site of Candida colonization. Invasion of infecting isolates could occur because of disruption of the barrier function of the gastrointestinal mucosa in relation to the comorbid gastrointestinal diseases, i.e. as a result of mucositis, perforation, or surgery [26].