Should vascular catheters be removed from all patients with candidemia? An evidence-based review

The removal of all central venous catheters (CVCs) from all patients with candidemia is considered to be standard care. However, this practice is not always possible, and it is associated with significant cost and potential complications. To evaluate the effect of CVC removal on the outcome of patients with candidemia, a literature review was conducted that selected studies that evaluated CVC removal as a prognostic factor (of mortality) in candidemia, performed a multivariate analysis with odds ratios and 95% confidence intervals, and included a validated severity of illness score. Of 203 studies of candidemia, only 4 fulfilled these criteria. One study showed a benefit from CVC removal in a subset of 21 neutropenic patients; another study showed no benefit; and the remaining 2 studies showed a marginal benefit from this strategy. Although it is possible that removal of CVCs may reduce the rate of complications due to candidemia, including death, the findings of this literature review do not substantiate this consensus recommendation.