Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections
José Garnacho-Montero1,2,3,, Ana Díaz-Martín1,2,3, Emilio García-Cabrera2,3, Maite Ruiz Pérez de Pipaón2,4, Clara Hernández-Caballero1,2 and José A. Lepe-Jiménez2,3,4+ Author Affiliations1Critical Care and Emergency Department, Intensive Care Unit, Virgen del Rocío University Hospital, Sevilla, Spain2Instituto de Biomedicina de Sevilla IBIS Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain3Spanish Network for Research in Infectious Disease REIPI, Virgen del Rocío University Hospital, Sevilla, Spain4Infectious Disease, Microbiology and Preventive Medicine Clinical Unit, Virgen del Rocío University Hospital, Sevilla, Spain↵Corresponding author. Critical Care and Emergency Department, Intensive Care Unit, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain. Tel: +34-955012235; Fax: +34-955012235; E-mail: firstname.lastname@example.orgemail@example.com
Received May 7, 2012.
Revision requested June 7, 2012.
Revision received July 22, 2012.Accepted July 31, 2012.
We set out to identify the prognostic factors in adult patients with Candida spp. bloodstream infection, assessing the impact on in-hospital mortality of catheter removal and adequacy of antifungal therapy.
Patients with positive blood culture for Candida spp. and a central venous catheter in place at the time of candidaemia were included. Data collected included demographics, underlying diseases, severity of illness, clinical presentation, catheter withdrawal and adequacy of empirical therapy.
We included 188 patients mortality 36.7%. The mortality rate was 34.9% 23/66 in patients with early adequate antifungal treatment and 18.9% 7/37 in patients with early adequate antifungal therapy and catheter withdrawal in the first 48 h. The APACHE Acute Physiology and Chronic Health Evaluation II score on the day of candidaemia [adjusted hazard ratio aHR 1.12; 95% CI 1.06–1.17; P < 0.001] was associated with death whereas early adequate therapy aHR 0.4; 95% CI 0.23–0.83; P = 0.012 and catheter withdrawal aHR 0.34; 95% CI 0.16–0.70; P = 0.03 were protective factors. In primary candidaemia, mortality was 28% 14/50 in patients with adequate therapy and decreased to 17.7% 6/34 in patients with both interventions in the first 48 h. Catheter removal was a protective factor and adequacy of antifungal therapy in the first 48 h showed a strong tendency to protection against death aHR 0.46; 95% CI 0.19–1.08; P = 0.07. In secondary non-catheter-related candidaemia, only early adequate therapy was a protective factor for mortality.
Delay in catheter withdrawal and in administration of adequate antifungal therapy was associated with increased mortality in candidaemic patients. Catheter management did not influence the prognosis of secondary non-catheter-related candidaemia.Key wordsBSIs candidaemia prognostic factors