title: Impact of early central venous catheter removal on outcome in patients with candidaemia.
abstract: Removal of central venous catheters (CVCs) from candidaemic patients is considered the reference standard of care, although this practice is not always possible. The impact of prompt catheter removal on outcome was investigated by analysing data from an active population-based surveillance study in Barcelona, Spain. Patients with candidaemia and a CVC were identified between January 2002 and December 2003. Cases with CVC removal within 2 days were classified as having early CVC removal. Outcome, defined as in-hospital mortality 2-30 days after diagnosis of candidaemia, was determined among hospitalised adults using univariate, Kaplan-Meier and multivariate logistic regression analysis. Outpatients, paediatric patients and those who died or were discharged within 2 days were excluded. The study identified 265 patients with candidaemia and a CVC. Median time from diagnosis of candidaemia to catheter removal was 1 day (range 0-29 days). Overall, 172 patients met the criteria for inclusion in the outcome study. Patients with early CVC removal differed significantly from those with delayed CVC removal. According to univariate, Kaplan-Meier and multivariate analysis, the marker most predictive of in-hospital mortality among candidaemic patients with CVCs was severity of illness. These data suggest that timing of CVC removal may best be determined after carefully considering the risks and benefits to individual patients.
authors.affiliation: Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Medicine Department, Barcelona, Spain. dolorodriguez@vhebron.net
authors.forename: D
authors.initials: D
authors.lastname: Rodriguez
authors.forename: B J
authors.initials: BJ
authors.lastname: Park
authors.forename: B
authors.initials: B
authors.lastname: Almirante
authors.forename: M
authors.initials: M
authors.lastname: Cuenca-Estrella
authors.forename: A M
authors.initials: AM
authors.lastname: Planes
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: M
authors.initials: M
authors.lastname: Gimenez
authors.forename: P
authors.initials: P
authors.lastname: Saballs
authors.forename: S K
authors.initials: SK
authors.lastname: Fridkin
authors.forename: J L
authors.initials: JL
authors.lastname: Rodriguez-Tudela
authors.forename: A
authors.initials: A
authors.lastname: Pahissa
mesh_terms: D018806:APACHE; D000328:Adult; D002177:Candidiasis / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D016469:Fungemia / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology