Visceral localizations and mortality in catheter-associated fungemia

Abstract

Purpose: To describe the prevalence of visceral localizations, risk factors and overall mortality at 3 months in catheter-associated fungemia in ICUs and non-ICUs Method: Retrospective study of patients with a fungal organism isolated on catheter blood culture. Clinical characteristics, visceral localizations, management and outcome were examined. Results: One hundred forty five patients presented primary or secondary fungemia (median age 61 years, 57% males). Sixty visceral localizations occurred in 50 patients (34.5%) including digestive (n= 21), pulmonary (n=11), vascular (n=6), spleen (n=4); muscle (n=3); cerebral (n=2); liver (n=2); ocular (n=2), hip prosthetic joint infection (n=1), spondylodiscitis (n=1) and abdominal wall (n=1). There was no statistical association between visceral localizations and fungal agent (p=0.208) or type of catheters (p=0.225). Fifty-two patients (36%) died during follow-up. Overall mortality was associated with retention of the central line catheter (p<0.01), type of catheter (p=0.004), Charlson Comorbidity Index (p< 0.01), inadequate or absence of antifungal therapy (p<0.01), hospitalization in an intensive care unit (p<0.01) and renal failure (p=0.02). Conclusion: Visceral localizations are common and not significantly associated with mortality in catheter-associated fungemia. Visceral localizations were not associated with the type of fungal agent and the type of catheter. Overall mortality is important and associated with important predisposing host conditions, the retention of the central line catheter and the type of catheter.