The catheter is not to blame
UAB researchers demonstrate that the early removal of venous central catheters does not improve the conditions of patients suffering from of candidaemia. The early removal of the CVC is a practice recommended in therapeutic guides, although the therapeutic advantage of this treatment has not been scientifically demonstrated. Apparently, this therapeutic advantage does not exist.
Removal of central venous catheters (CVC) from candidemic patients is considered standard of care, although this practice is not always possible. In the present study a controversial topic is tackled: the handling of venous central catheters in patients with candidaemia and the impact of its early removal on the mortality of these patients. The clinical information was obtained from all the candidaemias detected in 14 hospitals of the area of Barcelona during two years (2002 and 2003). We included in the study those patients who had been carrying a CVC before the candidaemia for at least 24 hours. The final aim of evaluation was the mortality between the 2nd and 30th after the diagnosis of the candidaemia. Paediatric patients were not included.
We analyzed 265 patients carrying a CVC and that suffering from candidaemia. The majority of the cases were primary candidaemias (251/265 [95%]); in 106 cases(45%) CVC caused the candidaemia, whereas in 145 (55%) cases the origin was not identified. C. albicans was the most frequent species (48%), continued of C. parapsilosis (26%), C. tropicalis (10%), C. glabrata (7%), C. krusei (4%) and other species (5 %).
In whole, 24 (9%) patients died in the first 48 hours after being diagnosed with candidaemia and 82 (31 %) died between the 2nd and 30th. The median of time between the diagnosis and the removal of the CVC was 1 day. 172 patients were included in a study to determine the characteristics associated with mortality in days 2-30 after the candidaemia.
Overall, the time to death among cases with early CVC removal, compared to non-early CVC-removal, was not significantly different, using Kaplan-Meier survival analysis. On multivariate analysis high severity of illness score was the strongest predictor of in-hospital mortality and C. parapsilosis isolate was associated with lower odds of death. Early CVC removal was not associated with a significantly decreased risk of in-hospital mortality.
In conclusion we confirm that severity of illness remains the most predictive marker of in-hospital mortality among candidemic patients with central venous catheters.
References
"Impact of early central venous catheter removal on outcome in patients with candidaemia" Rodriguez D, Park BJ, Almirante B, Cuenca-Estrella M, Planes AM, Mensa J, Gimenez M, Saballs P, Fridkin SK, Rodriguez-Tudela JL, Pahissa A; Barcelona Candidemia Project Study Group. Clin Microbiol Infect. 2007 Aug;13(8):788-93
