Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes.
We reviewed all 155 episodes of central venous catheter-associated fungemia among inpatients at the National Cancer Institute during a 10-year period. Candida species accounted for 98% of episodes. Fungemia was documented by culture of blood drawn through catheters in 50% of cases and by culture of both catheter-drawn and peripheral blood in 39%; mortality and the rate of dissemination were similar for these two groups. Four management strategies were used: catheter removal, antifungal therapy (with amphotericin B), both, or neither; indications for the use of both modes of treatment included fever, neutropenia, long-term indwelling catheterization, positive cultures of both catheter-drawn and peripheral blood, isolation of Candida tropicalis, and fungal isolation from two or more blood cultures. Disseminated fungal infection was documented in 82% of cases with these features but also in 35% of the less severe cases treated only with catheter removal. In addition, nine (82%) of 11 cases managed only with antifungal therapy had a negative outcome (either death from disseminated infection or the recurrence of fevers and/or fungemia), a finding suggesting that intravascular catheters should be removed in fungemia. Virtually all cases of catheter-associated fungemia in patients with cancer are clinically significant and require prompt therapy with amphotericin B.
Lecciones
J A
JA
Infectious Diseases Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
Lee
J W
JW
Navarro
E E
EE
Witebsky
F G
FG
Marshall
D
D
Steinberg
S M
SM
Pizzo
P A
PA
Walsh
T J
TJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D002177:Candidiasis / Q000209:etiology / Q000628:therapy; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology* / Q000628:therapy; D005260:Female; D016469:Fungemia / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies
D000666:Amphotericin B