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Venous catheter-associated candidemia
Abstract:
Fifty-five patients with venous catheter-associated candidemia were seen over a 13-year period. Thirty-five patients recovered from the infection. Twenty-six of these patients became afebrile within 72 hours of catheter removal; none were treated with systemic antifungal agents. Endophthalmitis appeared in four patients, three of whom had significant loss of vision. Nine patients had persistent candidemia following catheter removal and required antifungal therapy; none developed metastatic infection. Twenty other critically ill patients died during fungemia. Two of these patients were found to have Candida endocarditis that arose from previous catheter infections not suspected of being caused by this organism. Prevention of candidemia by proper care of indwelling vascular catheters is the ultimate goal. Appropriate management of the episodes of candidemia that occur may avert serious metastatic complications.
Insights
Catheter-associated candidemia can often be resolved by removing the venous catheter, avoiding systemic antifungal agents. Prompt management prevents serious metastatic complications like endophthalmitis or endocarditis.
Area of Science:
- Infectious Diseases
- Medical Mycology
- Critical Care Medicine
Background:
- Venous catheter-associated candidemia is a serious bloodstream infection.
- Candida species are a significant cause of hospital-acquired infections.
- Indwelling vascular catheters are a major risk factor for candidemia.
Purpose of the Study:
- To evaluate outcomes of catheter-associated candidemia.
- To determine the impact of catheter removal on recovery.
- To identify risk factors for metastatic complications.
Main Methods:
- Retrospective analysis of 55 patients with venous catheter-associated candidemia over 13 years.
- Assessment of clinical outcomes, including fever resolution, metastatic infections, and mortality.
- Correlation of outcomes with management strategies, particularly catheter removal and antifungal therapy.
Main Results:
- Thirty-five of 55 patients recovered; 26 became afebrile within 72 hours of catheter removal without systemic antifungal agents.
- Four patients developed endophthalmitis, with three experiencing significant vision loss.
- Nine patients with persistent candidemia post-catheter removal required antifungal therapy but did not develop metastatic infections.
- Twenty critically ill patients died during fungemia, including two with Candida endocarditis.
Conclusions:
- Venous catheter removal is crucial for resolving candidemia and preventing metastatic complications.
- Systemic antifungal therapy may be necessary for persistent infections but is not always required for initial recovery.
- Preventing candidemia through proper catheter care is paramount.
- Timely management of candidemia episodes can avert severe outcomes such as endophthalmitis and endocarditis.