Management of central venous catheters in patients with cancer and candidemia.
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.
Raad
Issam
I
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. iraad@mdanderson.org
Hanna
Hend
H
Boktour
Maha
M
Girgawy
Essam
E
Danawi
Hadi
H
Mardani
Masoud
M
Kontoyiannis
Dimitrios
D
Darouiche
Rabih
R
Hachem
Ray
R
Bodey
Gerald P
GP
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