Central venous catheter (CVC) removal for patients of all ages with candidaemia

Janum, Susanne; Afshari, Arash

doi:10.1002/14651858.cd011195.pub2

Cited by 31 publications

(30 citation statements)

References 114 publications

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“…We should be aware that all aforementioned studies, including the present one, were observational in design, possibly containing various biases and unmeasured potential confounders. No meta-analysis or randomized trials have yet been conducted to investigate the effect of early intervention in ICU patients with candidemia [17]. In the future, randomized studies targeting subgroups such as patients with septic shock due to candidemia could be considered, as several observational studies with positive results were derived from this population in the past [18,19].…”

Section: Discussionmentioning

confidence: 99%

Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study

et al. 2020

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Background: Candidemia is one of the most life-threatening infections among critically ill patients in the intensive care unit. However, the number of studies on the impact of host-and early treatment-related factors on mortality in this cohort is limited. The aim of this study was to investigate the relationship between clinically relevant factors, including early treatment (appropriate antifungal therapy and/or central venous catheter removal) and mortality in intensive care unit patients with candidemia. Methods: We performed a retrospective observational study in two Japanese University hospitals between January 2007 and December 2016. Adult intensive care unit patients with candidemia who met the following inclusion criteria: (1) ≥ 18 years old; (2) admitted in intensive care unit at the time of onset; and (3) central venous catheter in situ at the time of onset were included. We performed univariate and multivariate logistic regression analysis to identify factors associated with 30-day crude mortality. Results: A total of 68 patients met the inclusion criteria, 47 (69%) of whom were males. The median age was 68.0 (interquartile range, 61.0-76.0) years. The most common causative Candida species was Candida albicans (40 [59%] patients). With respect to the source of infection, central venous catheter-related candidemia was the most frequent (30 [44%] patients). Thirty-day crude mortality was 54% (37 patients). In multivariate logistic regression analysis, Acute Physiology and Chronic Health Evaluation II score (1-point increments) was the only factor that was independently associated with higher 30-day crude mortality. Other variables, including appropriate antifungal therapy and/or central venous catheter removal ≤ 24 h and ≤ 48 h following onset, did not significantly influence mortality. Conclusions: Candidemia in intensive care unit patients is still associated with high 30-day crude mortality rates. The only predictor of death was Acute Physiology and Chronic Health Evaluation II score ≤ 24 h following candidemia onset. Early empiric antifungal therapy and/or early CVC removal conferred no significant clinical benefit on survival in this patient population.

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Section: Discussionmentioning

confidence: 99%

Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study

et al. 2020

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“…In contrast, Raad and colleagues retrospectively analyzed 404 cancer patients with candidemia and CVCs and found that CVC removal within 72 h after onset of candidemia improved the response to antifungal therapy in patients with Candida-related CRBSI [199]. Similarly, findings from retrospective studies and a prospective cohort study in cancer patients with candidemia and systematic reviews indicate a decreased mortality in patients with CVC removal [204][205][206]. Therefore, prompt CVC removal is recommended in cancer patients with candidemia and yeast-related fungemias (e.g., Rhodotorula spp.)…”

Section: Catheter Removalmentioning

confidence: 99%

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

et al. 2020

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Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter–related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.

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“…An individual patient‐level quantitative review of randomised trials for treatment of invasive candidiasis that assessed the impact of host‐, organism‐ and treatment‐related factors on mortality, identified removal of the CVC as a factor associated with improved survival and clinical cure . Recently, Janum et al reviewed 73 observational studies that reported on various clinically relevant outcomes following catheter removal or retention in paediatric and adult patients with candidemia . Forty of these observational studies reported a beneficial effect of catheter removal, 33 showed no clear difference, while none reported results in favour of catheter retention.…”

Section: Cvcs and Paediatric Candidemiamentioning

confidence: 99%

“…73 Recently, Janum et al reviewed 73 observational studies that reported on various clinically relevant outcomes following catheter removal or retention in paediatric and adult patients with candidemia. 74 Forty of these observational studies reported a beneficial effect of catheter removal, 33 showed no clear difference, while none reported results in favour of catheter retention. However, these studies were exceedingly heterogeneous with regard to population, pathogens and interventions, and suffered from confounding by indication and a high risk of bias.…”

Section: Vc S and Paed Iatri C C And Idemiamentioning

confidence: 99%

Candidemia in children: Epidemiology, prevention and management

Mantadakis

Pana

Zaoutis

2018

Mycoses

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Candidemia is the leading cause of invasive fungal infections in hospitalised children. The highest rates of candidemia have been recorded in neonates and infants <1 year of age. Candidemia is more frequent in neonates and young infants than in adults, and is associated with better clinical outcomes, but higher inpatient costs. Over the last 10 years, a declining trend has been noted in the incidence of paediatric candidemia in the US and elsewhere due to the hospital-wide implementation of central-line insertion and maintenance bundles that emphasise full sterile barrier precautions, chlorhexidine skin preparation during line insertion, meticulous site and tubing care, and daily discussion of catheter necessity. Additional interventions aiming at reducing gut-associated candidemia are required in immunocompromised and critically ill children.

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Central venous catheter (CVC) removal for patients of all ages with candidaemia

Cited by 31 publications

References 114 publications

Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study

Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Candidemia in children: Epidemiology, prevention and management

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