title: Positive tip culture with Candida and negative blood culture: to treat or not to treat? A systematic review with meta-analysis.
abstract: BACKGROUND
  Invasive candidiasis is a major invasive fungal infection. It has high lethality, and even higher if not treated early. There is no consensus on antifungal treatment in patients with positive catheter tip culture for Candida spp. The objective of this study was to evaluate the impact of antifungal therapy and mortality of patients with positive culture for Candida spp. in catheter tip that have negative blood culture.
  
  
  METHODS
  The PubMed database was searched to identify articles related to Candida and catheter. Articles with adequate data were included.
  
  
  RESULTS
  Of 1208 studies initially screened, 5 met the selection criteria. All were retrospective studies. In all, 265 patients were evaluated for outcomes 'candidemia' and 'invasive candidiasis' and 158 for the outcome 'mortality.' Antifungal therapy had no impact on the development of invasive fungal disease (Odds ratio (OR) = 1.41; 95% confidence interval (CI) = 0.56-3.52). Also there was no benefit of therapy on mortality (OR = 1.02; 95% CI = 0.54-1.95).
  
  
  CONCLUSIONS
  Due to the poor quality of the studies no conclusion can be made. Randomized prospective studies are needed to better evaluate this therapeutic strategy.
authors.affiliation: From the Division of Infectious Diseases, Universidade Federal do Parana , Curitiba, PR , Brazil.
authors.forename: Bernardo Machado
authors.initials: BM
authors.lastname: De Almeida
authors.forename: Giovanni L
authors.initials: GL
authors.lastname: Breda
authors.forename: Flavio
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Tuon
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D057785:Catheters / Q000382:microbiology; D006801:Humans; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents