Outcome of treatment of candidemia in children whose central catheters were removed or retained

Pediatr Infect Dis J. 1989 Feb;8(2):99-104.

Abstract

In this study we reviewed the outcomes of all pediatric patients at Duke University Medical Center between 1978 and 1987 who were treated with amphotericin B and in whom Candida sp. fungemia occurred in the presence of a venous or arterial central catheter. Twenty-one episodes were evaluated for efficacy of either of 2 interventions. In 13 patients the catheter was removed and amphotericin B therapy was begun (Group 1), and in 8 patients, the catheter was retained and amphotericin B therapy was begun (Group 2). Persistent candidemia beyond onset of intervention occurred in 2 of the 13 patients in Group 1 and in 6 of the 8 patients in Group 2 (P = 0.018). In Group 1, 2 of the 13 patients subsequently developed new complications of candidiasis, and no patient died of causes related to candidiasis. In Group 2, 3 of the 8 patients had resolution of persistent candidemia only after catheter removal, 3 developed new complications of candidiasis after initiation of amphotericin B and 2 died with systemic candidal infection. Only one of the catheters initially retained was maintained successfully beyond the second week of amphotericin B therapy. We conclude that adverse outcomes (persistent fungemia, morbidity and mortality) are associated with attempts to maintain central catheters in the presence of candidemia.

Publication types

  • Comparative Study

MeSH terms

  • Amphotericin B / therapeutic use*
  • Blood / microbiology
  • Candida / isolation & purification
  • Candidiasis / drug therapy*
  • Candidiasis / etiology
  • Candidiasis / microbiology
  • Catheterization, Central Venous / adverse effects*
  • Female
  • Humans
  • Infant
  • Male
  • Time Factors

Substances

  • Amphotericin B