Central Venous Catheter Retention and Mortality in Children With Candidemia: A Retrospective Cohort Analysis

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Brian T Fisher1,2,3, Neika Vendetti1,2, Matthew Bryan4,3

  • 1Divisions of Infectious Diseases.

Journal of the Pediatric Infectious Diseases Society
|September 26, 2015
PubMed

Insights

Retaining a central venous catheter (CVC) in children with candidemia significantly increases the risk of death. Early CVC removal is recommended to improve outcomes for pediatric patients with bloodstream fungal infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Medical Device Infections
  • Critical Care Medicine

Background:

  • Candidemia presents a significant health challenge in pediatric populations, contributing to substantial morbidity and mortality.
  • While central venous catheter (CVC) removal is standard for adults with candidemia, pediatric data are scarce.
  • Limited evidence exists regarding the impact of CVC retention on outcomes in children with candidemia.

Purpose of the Study:

  • To investigate the association between central venous catheter (CVC) retention and 30-day all-cause mortality in pediatric patients with candidemia.
  • To provide pediatric-specific data to inform clinical guidelines on CVC management during candidemia.

Main Methods:

  • Retrospective cohort study of pediatric inpatients (<19 years) diagnosed with candidemia between 2000-2012.
  • Included patients with a CVC at blood culture and retained it for at least one day post-positive culture.
  • Utilized a discrete time failure model, adjusting for age and clinical care complexity, to analyze CVC retention's impact on mortality.

Main Results:

  • Identified 285 pediatric patients with candidemia and a CVC; 30 (10%) died within 30 days.
  • Central venous catheter retention was significantly associated with an increased daily risk of death (OR, 2.50; 95% CI, 1.06-5.91).

Conclusions:

  • CVC retention in pediatric candidemia patients is linked to a higher risk of mortality, even after adjusting for confounding factors.
  • The findings suggest that early removal of CVCs should be strongly considered in children diagnosed with candidemia.
  • Further research may be needed to address potential unmeasured confounding variables.
Abstract

Keywords:
candidemiacentral cathetermortalitypediatrics

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