Candidemia in cancer patients: impact of early removal of non-tunneled central venous catheters on outcome.
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.
Liu
C Y
CY
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Huang
L J
LJ
Wang
W S
WS
Chen
T L
TL
Yen
C C
CC
Yang
M H
MH
Hsiao
L T
LT
Liu
C Y
CY
Chen
P M
PM
Chiou
T J
TJ
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