Is Candida colonization of central vascular catheters in non-candidemic, non-neutropenic patients an indication for antifungals?

Intensive Care Med. 2009 Apr;35(4):707-12. doi: 10.1007/s00134-009-1431-6. Epub 2009 Feb 11.

Abstract

Purpose: To assess the influence of antifungal therapy on the outcome of non-candidemic adult patients with central vascular catheter (CVC) tips colonized by Candida species.

Methods: A retrospective analysis of the outcome of patients with Candida colonization of their CVC tip and no concurrent candidemia was made over a 4-year period. Patients who either died or developed candidemia-invasive candidiasis (poor outcome) were compared with those who improved.

Results: We finally included 58 patients for analysis. Almost all (91.4%) had to be admitted to the ICU during their hospital stay. Independent predictors for outcome were a McCabe and Jackson score corresponding to ultimately fatal underlying disease [odds ratio (OR) 11.98; 95% confidence interval (CI), 1.37-104.97; P = 0.02], and maximum severity corresponding to severe sepsis, septic shock or multiorgan failure (OR: 6.16, CI 95%: 1.00-37.93; P = 0.05). We were unable to demonstrate that antifungal therapy was an independent variable influencing outcome (OR 0.82; 95% CI, 0.27-2.47; P = 0.73).

Conclusions: Our data suggest that, in non-neutropenic critically ill patients with no concomitant candidemia and with CVC tips colonized by Candida, antifungal therapy does not seem to have a significant influence on clinical outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Candida albicans / isolation & purification
  • Candidiasis / drug therapy*
  • Candidiasis / microbiology*
  • Caspofungin
  • Catheterization, Central Venous*
  • Catheters, Indwelling / microbiology*
  • Disease Progression
  • Echinocandins / therapeutic use*
  • Female
  • Fluconazole / therapeutic use*
  • Humans
  • Lipopeptides
  • Male
  • Middle Aged
  • Retrospective Studies
  • Statistics, Nonparametric

Substances

  • Antifungal Agents
  • Echinocandins
  • Lipopeptides
  • Fluconazole
  • Caspofungin