title: Candidemia in cancer patients: impact of early removal of non-tunneled central venous catheters on outcome.
abstract: OBJECTIVE
  To explore the impact of retention of non-tunneled central venous catheters (CVCs) on survival in candidemic cancer patients, where CVCs are commonly used and essential. A second object was to determine whether early CVC removal would benefit a subset of cancer patients.
  
  
  METHODS
  We retrospectively evaluated 92 cancer patients who had a single, non-tunneled CVC in place. Patients were grouped according to CVC retention or removal; the later group was subdivided into early (CVC removed <or=72h after candidemia onset) and late removal. A Cox regression model was used for determining risk factors of adverse outcome and Kaplan-Meier analyses for comparing in-hospital 3-30 day survival among subgroups.
  
  
  RESULTS
  Baseline characteristics were comparable between CVC retention (n=20) or removal (n=72) groups. CVC retention was a significant risk factor of poor outcome, independent of other significant prognostic host factors (hazard ratio 7.15, 95% confidence interval 3.51-14.53, p<0.001). Patients of early CVC removal (n=40) had significant better survival than those of late removal (n=32) (p<0.001).
  
  
  CONCLUSIONS
  The results suggest that retention of CVCs has a negative impact on survival in candidemic cancer patients, and that early CVC removal should be considered in a subset of cancer patients with candidemia.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: C Y
authors.initials: CY
authors.lastname: Liu
authors.forename: L J
authors.initials: LJ
authors.lastname: Huang
authors.forename: W S
authors.initials: WS
authors.lastname: Wang
authors.forename: T L
authors.initials: TL
authors.lastname: Chen
authors.forename: C C
authors.initials: CC
authors.lastname: Yen
authors.forename: M H
authors.initials: MH
authors.lastname: Yang
authors.forename: L T
authors.initials: LT
authors.lastname: Hsiao
authors.forename: C Y
authors.initials: CY
authors.lastname: Liu
authors.forename: P M
authors.initials: PM
authors.lastname: Chen
authors.forename: T J
authors.initials: TJ
authors.lastname: Chiou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000401:mortality / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D016469:Fungemia / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome