Should vascular catheters be removed from all patients with candidemia? An evidence-based review.

@article{Nucci2002ShouldVC,
  title={Should vascular catheters be removed from all patients with candidemia? An evidence-based review.},
  author={Marcio Nucci and Elias J. Anaissie},
  journal={Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
  year={2002},
  volume={34 5},
  pages={
          591-9
        }
}
  • M. Nucci, E. Anaissie
  • Published 1 March 2002
  • Medicine
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
The removal of all central venous catheters (CVCs) from all patients with candidemia is considered to be standard care. However, this practice is not always possible, and it is associated with significant cost and potential complications. To evaluate the effect of CVC removal on the outcome of patients with candidemia, a literature review was conducted that selected studies that evaluated CVC removal as a prognostic factor (of mortality) in candidemia, performed a multivariate analysis with… 
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Impact of early central venous catheter removal on outcome in patients with candidaemia.
  • D. Rodríguez, B. Park, +8 authors A. Pahissa
  • Medicine
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2007
TLDR
The data suggest that timing of CVC removal may best be determined after carefully considering the risks and benefits to individual patients, and the marker most predictive of in-hospital mortality among candidaemic patients with CVCs was severity of illness.
Management of central venous catheters in patients with cancer and candidemia.
  • I. Raad, H. Hanna, +7 authors G. Bodey
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2004
TLDR
CVC removal < or =72 h after onset should be considered in patients with suspected catheter-related candidemia who have no evidence of dissemination, recent corticosteroid therapy, or chemotherapy.
Removal of central venous catheters from patients with candidemia.
  • L. Lazzarini, R. Luzzati
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2002
TLDR
Comments from the authors of a retrospective study that found removal of central venous catheters was associated with a significant decrease in the mortality rate were surprised by the interpretation of some of the data.
The importance of central venous catheter removal in patients with candidaemia: time to rethink our practice?
  • A. Pasqualotto, L. C. Severo
  • Medicine, Biology
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2008
TLDR
Until evidence of a properly designed randomised trial that controls for confounding variables is available, systematic removal of all CVCs in patients with candidaemia seems not to be justified.
Time of catheter removal in candidemia and mortality.
Early removal of central venous catheter in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical trials.
  • M. Nucci, E. Anaissie, +5 authors O. Lortholary
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2010
TLDR
In this cohort of 842 adults with candidemia followed up prospectively, early CVC removal was not associated with any clinical benefit, and an evidence-based re-evaluation of current treatment recommendations is suggested.
Candidemia in cancer patients: impact of early removal of non-tunneled central venous catheters on outcome.
Epidemiology and mortality of candidemia both related and unrelated to the central venous catheter: a retrospective cohort study
TLDR
When the origin of candidemia was not the CVC, patients were more seriously ill, had a higher mortality rate, and the removal of the catheter seemed to lead to disappointing results.
Central venous catheter (CVC) removal for patients of all ages with candidaemia.
TLDR
The main purpose of this review is to examine the impact of removing versus retaining a CVC on mortality in adults and children with candidaemia who have a central venous catheter in place and find no eligible RCTs or quasi-RCTs to support these practices and therefore could draw no firm conclusions.
Factors prompting early central venous catheter removal from cancer patients with candidaemia
TLDR
A propensity to immediately remove short-term catheters and a tendency for early removal in patients undergoing active cancer treatment are shown and there was no benefit of early catheter removal with regard to overall mortality.
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References

SHOWING 1-10 OF 36 REFERENCES
Should Central Venous Catheters Be Removed as Soon as Candidemia Is Detected in Neonates?
TLDR
Failure to remove CVC as soon as candidemia was detected in neonates was associated with significantly increased mortality in C albicans candidemia and prolonged duration of candidemia regardless of Candidaspecies.
Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes.
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    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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TLDR
Virtually all cases of catheter-associated fungemia in patients with cancer are clinically significant and require prompt therapy with amphotericin B, a finding suggesting that intravascular catheters should be removed in fungemia.
Outcome of treatment of candidemia in children whose central catheters were removed or retained.
TLDR
It is concluded that adverse outcomes (persistent fungemia, morbidity and mortality) are associated with attempts to maintain central catheters in the presence of candidemia.
Outcome of treatment of candidemia in children whose central catheters were removed or retained.
TLDR
It is concluded that adverse outcomes (persistent fungemia, morbidity and mortality) are associated with attempts to maintain central catheters in the presence of candidemia.
Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy
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  • Medicine, Biology
    The Pediatric infectious disease journal
  • 1990
TLDR
Complications were significantly more common in infants than in older children, and appeared 3 to 52 days after the first positive blood culture, and Prompt catheter removal remains crucial in the treatment of catheter-related candidemia.
Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study.
TLDR
Fluconazole seems to be an alternative therapeutic option to amphotericin B in selected patients with candidemia, and was as efficacious as amphoteric in B in the therapy of candidemia even when stratified by risk factors for mortality.
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TLDR
The data suggest that patients with candidemia and a central venous catheter should have the catheter removed, and older age and nonremoval of acentral venousCatheter were the only factors associated with an increased risk for death.
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    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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TLDR
The results of this study suggest that mortality associated with candidemia is lower among children than among adults; that failure to remove the indwelling intravenous catheter usually results in a poor outcome; that candiduria rarely precedes candidemia in children; and that amphotericin B is well tolerated by children.
Predictors of adverse outcome in cancer patients with candidemia.
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TLDR
It remains to be shown in controlled clinical trials whether limiting the number of antibiotics or instituting prophylaxis and/or early treatment for high-risk patients will reduce the incidence of nosocomial candidemia.
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