title: A single center's experience with Candida parapsilosis related long-term central venous access device infections: the port removal decision and its outcomes.
abstract: Pediatric cancer patients have an increased risk of potentially life-threatening fungal infections such as Candida parapsilosis, associated with long-term CVADs. The Infectious Diseases Society of America (IDSA) guidelines on Candida catheter-related bloodstream infections recommend systemic antifungal therapy and catheter removal. In this study, we focused on our experience with antifungal failure due to totally implanted catheter-associated C. parapsilosis bloodstream infections. We investigated cases leading to port removal in pediatric malignancy patients and the associated patient outcomes. In the first phase of the study, a retrospective chart review was performed to collect patient information, including primary disease; time from hospitalization to port-related candidemia; antifungal drug choice; and the time at which port removal occurred. During the second phase, antifungal susceptibility tests for C. parapsilosis were performed in our microbiology laboratory. All patients had fevers and were neutropenic at the time of candidemia diagnosis. The mean duration between the first isolation of Candida parapsilosis from the port samples to the port removal was 9.75 ± 5.29 days for 11 patients. Patient fevers lasted for a mean time of 16.22 ± 6.51 days. The median recovery duration from fever after CVC removal was four days (range 2-12 days). The median duration for achieving negative blood cultures, following antifungal treatment was 18 days (range 10-27 days). Our data favored the removal of catheters in the presence of ongoing fever, as suggested by the guidelines, independent of the chosen antifungal treatment. Future studies with large samples are needed to evaluate the effects of catheter removal on mortality rates and patient outcomes.
authors.affiliation: 1Division of Pediatric Infectious Disease, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Devrim
authors.forename: Yöntem
authors.initials: Y
authors.lastname: Yaman
authors.forename: Bengü
authors.initials: B
authors.lastname: Demirağ
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Oymak
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Cartı
authors.forename: Gülcihan
authors.initials: G
authors.lastname: Özek
authors.forename: Sener
authors.initials: S
authors.lastname: Tulumoğlu
authors.forename: Tülin
authors.initials: T
authors.lastname: Erdem
authors.forename: Gülfidan
authors.initials: G
authors.lastname: Gamze
authors.forename: Salih
authors.initials: S
authors.lastname: Gözmen
authors.forename: Burçak Tatlı
authors.initials: BT
authors.lastname: Güneş
authors.forename: Nuri
authors.initials: N
authors.lastname: Bayram
authors.forename: Canan
authors.initials: C
authors.lastname: Vergin
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage*; D001798:Blood Proteins; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D005334:Fever / Q000188:drug therapy; D016469:Fungemia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy
chemical_list: D000935:Antifungal Agents; D001798:Blood Proteins; C067495:Candida procidin
keywords: infectious diseases; leukemia; lymphoma; neuroblastoma; neutropenia