title: Candidemic complications in patients with intravascular catheters colonized with Candida species: an indication for preemptive antifungal therapy?
abstract: BACKGROUND
  The impact of Candida-colonized catheter tips in patients without candidemia is unclear.
  
  
  METHODS
  A retrospective study of patients with tip cultures positive for Candida was conducted over an 8-year period, to determine the outcomes in patients with Candida cultured from an intravascular catheter tip in the absence of preceding Candida-positive blood cultures. The primary outcome measure was definite candidemia. Secondary outcomes included possible candidemia and in-hospital mortality. A possible candidemia was defined as clinical signs and symptoms of invasive candidiasis without explanation other than a candidemia, but with negative blood cultures.
  
  
  RESULTS
  Sixty-eight cultures from 64 patients were included in the study. Definite candidemia developed in three cases (4%) and possible candidemia developed in five cases (7%). In-hospital mortality was significantly increased in patients with definite or possible candidemia (63% vs. 22%, p=0.028). Risk factors for the development of definite or possible candidemia were catheter time in situ >8 days (odds ratio (OR) 6.0, 95% confidence interval (CI) 1.1-32.9) and abdominal surgery (OR 6.0, 95% CI 1.1-32.4).
  
  
  CONCLUSIONS
  Intravascular catheter tip colonization in patients without preceding blood cultures with Candida is associated with candidemia in from 4% of patients (definite candidemia) up to 12% of patients (definite and possible candidemia combined). Considering the adverse prognosis associated with delayed treatment of candidemia, preemptive treatment based on catheter tip cultures might outweigh the disadvantages of costs and side effects of antifungal therapy.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre, Utrecht, The Netherlands.
authors.forename: N H J
authors.initials: NH
authors.lastname: Leenders
authors.forename: J J
authors.initials: JJ
authors.lastname: Oosterheert
authors.forename: M B
authors.initials: MB
authors.lastname: Ekkelenkamp
authors.forename: D W
authors.initials: DW
authors.lastname: De Lange
authors.forename: A I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: E J G
authors.initials: EJ
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D003470:Culture Media