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We evaluated the impact of delayed CVC removal on mortality according to the severity of comorbidities in patients with candidaemia” Lee et al (2019).

Abstract:

Background: The effects of early central venous catheter (CVC) removal on the clinical outcomes of patients with candidaemia remain controversial. We evaluated the impact of delayed CVC removal on mortality according to the severity of comorbidities in patients with candidaemia.

Methods: Patients with candidaemia in our tertiary care hospital between January 2010 and December 2017 were retrospectively included. The severity of comorbidities was classified as low [Charlson comorbidity index (CCI) score ≤3] and high (CCI score ≥4). Cases with removal of CVC > 2 days following onset of candidaemia or without CVC removal were classified as having delayed CVC removal.

Results: In total, 239 patients with candidaemia were included, excluding 18 who died within 2 days of candidaemia. Of these, 149 had low CCI scores and 90 had high CCI scores. Septic shock (aOR=9.5) and delayed CVC removal (aOR=4.7) were significantly associated with increased 30-day mortality, whereas Candida parapsilosis infection (aOR=0.2) and cerebrovascular disease (aOR=0.3) were associated with decreased 30-day mortality, in patients with low CCI scores. Septic shock (aOR=13.0) was the only risk factor for 30-day mortality in those with high CCI scores. Delayed CVC removal was associated with increased 30-day mortality in patients with low CCI scores (50.0% vs. 20.3%; P = 0.001), but not in those with high CCI scores (50.0% vs. 47.9%; P = 0.87).

Conclusion: Early CVC removal may improve the survival of patients with candidaemia and low CCI scores, but no such protective effect was evident in those with high CCI scores.

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Reference:
Lee, Y-M., Kim, D.Y., Kim, Y.J., Park, K-H. and Lee, M.S. (2019) Clinical impacts of delayed central venous catheter removal according to the severity of comorbidities in patients with candidaemia. The Journal of Hospital Infection. September 4th. DOI: https://doi.org/10.1016/j.jhin.2019.08.018. [epub ahead of print].