title: Management of central venous catheters in patients with cancer and candidemia.
abstract: To determine the need and appropriate timing of catheter removal in patients with candidemia, the records for 404 patients with cancer and central venous catheters (CVCs) who developed candidemia during the period of 1993-1998 were retrospectively reviewed. Of the total 404 cases of candidemia, 241 (60%) were due to a primary source, 111 (27%) were catheter related, and 52 (13%) were secondary cases of candidemia caused by a source other than the catheter. Multivariate analysis showed that catheter removal < or =72 h after onset improved response to antifungal therapy exclusively in patients with catheter-related candidemia (P=.04). Clinical characteristics that suggested a noncatheter source for the candidemia were disseminated infection (P<.01), previous chemotherapy (P<.01), previous corticosteroid therapy (P=.02), and poor response to antifungal therapy (P<.03). CVC removal < or =72 h after onset should be considered in patients with suspected catheter-related candidemia who have no evidence of dissemination, recent corticosteroid therapy, or chemotherapy.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. iraad@mdanderson.org
authors.forename: Issam
authors.initials: I
authors.lastname: Raad
authors.forename: Hend
authors.initials: H
authors.lastname: Hanna
authors.forename: Maha
authors.initials: M
authors.lastname: Boktour
authors.forename: Essam
authors.initials: E
authors.lastname: Girgawy
authors.forename: Hadi
authors.initials: H
authors.lastname: Danawi
authors.forename: Masoud
authors.initials: M
authors.lastname: Mardani
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kontoyiannis
authors.forename: Rabih
authors.initials: R
authors.lastname: Darouiche
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Bodey
mesh_terms: D002177:Candidiasis / Q000150:complications* / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D016469:Fungemia / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D016459:Prosthesis-Related Infections / Q000150:complications / Q000382:microbiology; D012189:Retrospective Studies