Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections

• Published in: Journal of antimicrobial chemotherapy Vol. 68; no. 1; pp. 206 - 213
• Main Authors: Garnacho-Montero, José, Díaz-Martín, Ana, García-Cabrera, Emilio, Ruiz Pérez de Pipaón, Maite, Hernández-Caballero, Clara, Lepe-Jiménez, José A
• Format: Journal Article
• Language: English
• Published: England Oxford Publishing Limited (England) 01.01.2013
• Subjects: Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Blood culture; Candida; Candida - drug effects; Candidemia - drug therapy; Candidemia - mortality; Catheter-Related Infections - drug therapy; Catheter-Related Infections - mortality; Catheters; Clinical outcomes; Cohort Studies; Data processing; Demography; Device Removal - mortality; Drug therapy; Female; Fungal infections; Hospital Mortality - trends; Hospitals; Humans; Male; Middle Aged; Mortality; Nosocomial infections; Prognosis; Prospective Studies
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dks347

We set out to identify the prognostic factors in adult patients with Candida spp. bloodstream infection, assessing the impact on in-hospital mortality of catheter removal and adequacy of antifungal therapy. Patients with positive blood culture for Candida spp. and a central venous catheter in place at the time of candidaemia were included. Data collected included demographics, underlying diseases, severity of illness, clinical presentation, catheter withdrawal and adequacy of empirical therapy. We included 188 patients (mortality 36.7%). The mortality rate was 34.9% (23/66) in patients with early adequate antifungal treatment and 18.9% (7/37) in patients with early adequate antifungal therapy and catheter withdrawal in the first 48 h. The APACHE (Acute Physiology and Chronic Health Evaluation) II score on the day of candidaemia [adjusted hazard ratio (aHR) 1.12; 95% CI 1.06-1.17; P < 0.001] was associated with death whereas early adequate therapy (aHR 0.4; 95% CI 0.23-0.83; P = 0.012) and catheter withdrawal (aHR 0.34; 95% CI 0.16-0.70; P = 0.03) were protective factors. In primary candidaemia, mortality was 28% (14/50) in patients with adequate therapy and decreased to 17.7% (6/34) in patients with both interventions in the first 48 h. Catheter removal was a protective factor and adequacy of antifungal therapy in the first 48 h showed a strong tendency to protection against death (aHR 0.46; 95% CI 0.19-1.08; P = 0.07). In secondary non-catheter-related candidaemia, only early adequate therapy was a protective factor for mortality. Delay in catheter withdrawal and in administration of adequate antifungal therapy was associated with increased mortality in candidaemic patients. Catheter management did not influence the prognosis of secondary non-catheter-related candidaemia.