title: Outcome of treatment of candidemia in children whose central catheters were removed or retained.
abstract: In this study we reviewed the outcomes of all pediatric patients at Duke University Medical Center between 1978 and 1987 who were treated with amphotericin B and in whom Candida sp. fungemia occurred in the presence of a venous or arterial central catheter. Twenty-one episodes were evaluated for efficacy of either of 2 interventions. In 13 patients the catheter was removed and amphotericin B therapy was begun (Group 1), and in 8 patients, the catheter was retained and amphotericin B therapy was begun (Group 2). Persistent candidemia beyond onset of intervention occurred in 2 of the 13 patients in Group 1 and in 6 of the 8 patients in Group 2 (P = 0.018). In Group 1, 2 of the 13 patients subsequently developed new complications of candidiasis, and no patient died of causes related to candidiasis. In Group 2, 3 of the 8 patients had resolution of persistent candidemia only after catheter removal, 3 developed new complications of candidiasis after initiation of amphotericin B and 2 died with systemic candidal infection. Only one of the catheters initially retained was maintained successfully beyond the second week of amphotericin B therapy. We conclude that adverse outcomes (persistent fungemia, morbidity and mortality) are associated with attempts to maintain central catheters in the presence of candidemia.
authors.affiliation: Division of Infectious Diseases, Alfred I. duPont Institute, Wilmington, DE 19899.
authors.forename: S C
authors.initials: SC
authors.lastname: Eppes
authors.forename: J L
authors.initials: JL
authors.lastname: Troutman
authors.forename: L T
authors.initials: LT
authors.lastname: Gutman
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D001769:Blood / Q000382:microbiology; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013997:Time Factors
chemical_list: D000666:Amphotericin B