Factors prompting early central venous catheter removal from cancer patients with candidaemia.
We evaluated clinical factors associated with early central venous catheter (CVC) removal in cancer patients with candidaemia who survived >3 days after the index blood culture. This was a retrospective cohort study from a previous candidaemia database conducted between January 2001 and June 2005. Eligible patients were those whose catheters were removed. Those who died in the first 72 h were excluded. Early CVC removal was defined as withdrawal in the first 72 h. We enrolled 164 patients with a 10.4% mortality rate. Multivariate analysis showed temporary non-tunnelled catheter type (odds ratio 5.06; 95% confidence interval 2.16-11.83) as the only variable associated with early removal. Among the 84 episodes judged not catheter-related, 52 CVCs were removed due to the need for further cancer treatment. No differences in mortality were seen among patients with early or late catheter removal. Stratified analysis showed a survival benefit (p = 0.04) of early removal among patients with a Karnofsky performance status score >60. The study shows a propensity to immediately remove short-term catheters and a tendency for early removal in patients undergoing active cancer treatment. There was no benefit of early catheter removal with regard to overall mortality. The favourable impact of early over late removal on survival among patients without significant illness merits further investigation.
Velasco
Eduardo
E
Infectious Diseases Department, Infection Control Committee, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. evelasco@inca.gov.br
Portugal
Rodrigo Doyle
RD
D000328:Adult; D058387:Candidemia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057785:Catheters / Q000145:classification; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D028761:Withholding Treatment / Q000706:statistics & numerical data*