title: Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections.
abstract: OBJECTIVE
  We set out to identify the prognostic factors in adult patients with Candida spp. bloodstream infection, assessing the impact on in-hospital mortality of catheter removal and adequacy of antifungal therapy.
  
  
  METHODS
  Patients with positive blood culture for Candida spp. and a central venous catheter in place at the time of candidaemia were included. Data collected included demographics, underlying diseases, severity of illness, clinical presentation, catheter withdrawal and adequacy of empirical therapy.
  
  
  RESULTS
  We included 188 patients (mortality 36.7%). The mortality rate was 34.9% (23/66) in patients with early adequate antifungal treatment and 18.9% (7/37) in patients with early adequate antifungal therapy and catheter withdrawal in the first 48 h. The APACHE (Acute Physiology and Chronic Health Evaluation) II score on the day of candidaemia [adjusted hazard ratio (aHR) 1.12; 95% CI 1.06-1.17; P < 0.001] was associated with death whereas early adequate therapy (aHR 0.4; 95% CI 0.23-0.83; P = 0.012) and catheter withdrawal (aHR 0.34; 95% CI 0.16-0.70; P = 0.03) were protective factors. In primary candidaemia, mortality was 28% (14/50) in patients with adequate therapy and decreased to 17.7% (6/34) in patients with both interventions in the first 48 h. Catheter removal was a protective factor and adequacy of antifungal therapy in the first 48 h showed a strong tendency to protection against death (aHR 0.46; 95% CI 0.19-1.08; P = 0.07). In secondary non-catheter-related candidaemia, only early adequate therapy was a protective factor for mortality.
  
  
  CONCLUSIONS
  Delay in catheter withdrawal and in administration of adequate antifungal therapy was associated with increased mortality in candidaemic patients. Catheter management did not influence the prognosis of secondary non-catheter-related candidaemia.
authors.affiliation: Critical Care and Emergency Department, Intensive Care Unit,  Virgen del Rocío University Hospital, Sevilla,  Spain.
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Ana
authors.initials: A
authors.lastname: Díaz-Martín
authors.forename: Emilio
authors.initials: E
authors.lastname: García-Cabrera
authors.forename: Maite
authors.initials: M
authors.lastname: Ruiz Pérez de Pipaón
authors.forename: Clara
authors.initials: C
authors.lastname: Hernández-Caballero
authors.forename: José A
authors.initials: JA
authors.lastname: Lepe-Jiménez
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects; D058387:Candidemia / Q000188:drug therapy* / Q000401:mortality*; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000401:mortality*; D015331:Cohort Studies; D020878:Device Removal / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents