title: Central Venous Catheter Retention and Mortality in Children With Candidemia: A Retrospective Cohort Analysis.
abstract: BACKGROUND
  Candidemia causes significant morbidity and mortality among children. Removal of a central venous catheter (CVC) is often recommended for adults with candidemia to reduce persistent and metastatic infection. Pediatric-specific data on the impact of CVC retention are limited.
  
  
  METHODS
  A retrospective cohort study of inpatients <19 years with candidemia at the Children's Hospital of Philadelphia between 2000 and 2012 was performed. The final cohort included patients that had a CVC in place at time of blood culture and retained their CVC at least 1 day beyond the blood culture being positive. A structured data collection instrument was used to retrieve patient data. A discrete time failure model, adjusting for age and the complexity of clinical care before onset of candidemia, was used to assess the association of CVC retention and 30-day all-cause mortality.
  
  
  RESULTS
  Two hundred eighty-five patients with candidemia and a CVC in place at the time of blood culture were identified. Among these 285 patients, 30 (10%) died within 30 days. Central venous catheter retention was associated with a significant increased risk of death on a given day (odds ratio, 2.50; 95% confidence interval, 1.06-5.91).
  
  
  CONCLUSIONS
  Retention of a CVC was associated with an increased risk of death after adjusting for age and complexity of care at candidemia onset. Although there is likely persistence of unmeasured confounding, given the strong association between catheter retention and death, our data suggest that early CVC removal should be strongly considered.
authors.affiliation: Divisions of Infectious Diseases.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Fisher
authors.affiliation: Divisions of Infectious Diseases.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Neika
authors.initials: N
authors.lastname: Vendetti
authors.affiliation: Department of Pediatrics.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bryan
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco.
authors.forename: Priya A
authors.initials: PA
authors.lastname: Prasad
authors.affiliation: Department of Pediatrics.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: A
authors.initials: A
authors.lastname: Russell Localio
authors.affiliation: Divisions of Infectious Diseases.
authors.forename: Andreas
authors.initials: A
authors.lastname: Damianos
authors.affiliation: Divisions of Infectious Diseases.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: Divisions of Infectious Diseases.|Department of Pediatrics.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
authors.affiliation: Transplantation-Oncology Infectious Diseases, New York-Presbyterian Hospital/Weill Cornell Medical Center.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.|Philadelphia Veterans Affairs Medical Center, Pennsylvania.
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.affiliation: Divisions of Infectious Diseases.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
mesh_terms: D000293:Adolescent; D058387:Candidemia / Q000382:microbiology / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: candidemia; central catheter; mortality; pediatrics