Does a diagnosis of candidemia require early CVC removal

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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

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.

Reference:

Fisher, B.T., Vendetti, N., Bryan, M., Prasad, P.A., Russell Localio, A., Damianos, A., Coffin, S.E., Bell, L.M., Walsh, T.J., Gross, R. and Zaoutis, T.E. (2015) Central Venous Catheter Retention and Mortality in Children With Candidemia: A Retrospective Cohort Analysis. Journal of the Pediatric Infectious Diseases Society. August 16th. [epub ahead of print].

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