Skip to main content

Advertisement

SpringerLink
Log in

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

  • Brief Report
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Dimopoulos G, Karabinis A, Samonis G, Falagas ME (2007) Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study. Eur J Clin Microbiol Infect Dis 26:377–384

    Article  PubMed  CAS  Google Scholar 

  2. Charles PE, Doise JM, Quenot JP, Aube H, Dalle F, Chavanet P, Milesi N, Aho LS, Portier H, Blettery B (2003) Candidemia in critically ill patients: difference of outcome between medical and surgical patients. Intensive Care Med 29:2162–2169

    Article  PubMed  Google Scholar 

  3. Falagas ME, Apostolou KE, Pappas VD (2006) Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies. Eur J Clin Microbiol Infect Dis 25:419–425

    Article  PubMed  CAS  Google Scholar 

  4. Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, Harrison LH, Seaberg EC, Hajjeh RA, Teutsch SM (2005) Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance. Infect Control Hosp Epidemiol 26:540–547

    Article  PubMed  Google Scholar 

  5. Pappas PG (2006) Invasive candidiasis. Infect Dis Clin North Am 20:485–506

    Article  PubMed  Google Scholar 

  6. Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE (2004) Guidelines for treatment of candidiasis. Clin Infect Dis 38:161–189

    Article  PubMed  Google Scholar 

  7. Leon C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, Garnacho-Montero J, Leon MA (2006) A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 34:730–737

    Article  PubMed  Google Scholar 

  8. Alvarez-Lerma F, Palomar M, Olaechea P, Otal JJ, Insausti J, Cerda E (2007) National Study of Control of Nosocomial Infection in Intensive Care Units. Evolutive report of the years 2003–2005. Med Intensiva 31:6–17

    Article  PubMed  CAS  Google Scholar 

  9. Bouza E, San Juan R, Munoz P, Pascau J, Voss A, Desco M (2004) A European perspective on intravascular catheter-related infections: report on the microbiology workload, aetiology and antimicrobial susceptibility (ESGNI-005 Study). Clin Microbiol Infect 10:838–842

    Article  PubMed  CAS  Google Scholar 

  10. Vincent JL (2003) Nosocomial infections in adult intensive-care units. Lancet 361:2068–2077

    Article  PubMed  Google Scholar 

  11. Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 27:887–892

    Article  PubMed  CAS  Google Scholar 

  12. Rangel-Frausto MS, Wiblin T, Blumberg HM, Saiman L, Patterson J, Rinaldi M, Pfaller M, Edwards JE Jr, Jarvis W, Dawson J, Wenzel RP (1999) National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 29:253–258

    Article  PubMed  CAS  Google Scholar 

  13. Luzzati R, Amalfitano G, Lazzarini L, Soldani F, Bellino S, Solbiati M, Danzi MC, Vento S, Todeschini G, Vivenza C, Concia E (2000) Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 19:602–607

    Article  PubMed  CAS  Google Scholar 

  14. Khatib R, Clark JA, Briski LE, Wilson FM (1995) Relevance of culturing Candida species from intravascular catheters. J Clin Microbiol 33:1635–1637

    PubMed  CAS  Google Scholar 

  15. Sandven P, Giercksky KE (2001) Yeast colonization in surgical patients with intra-abdominal perforations. Eur J Clin Microbiol Infect Dis 20:475–481

    Article  PubMed  CAS  Google Scholar 

  16. Mermel LA, Farr BM, Sherertz RJ, Raad II, O’Grady N, Harris JS, Craven DE (2001) Guidelines for the management of intravascular catheter-related infections. J Intraven Nurs 24:180–205

    PubMed  CAS  Google Scholar 

  17. Bouza E, Alvarado N, Alcala L, Sanchez-Conde M, Perez MJ, Munoz P, Martin-Rabadan P, Rodriguez-Creixems M (2005) A prospective, randomized, and comparative study of 3 different methods for the diagnosis of intravascular catheter colonization. Clin Infect Dis 40:1096–1100

    Article  PubMed  Google Scholar 

  18. Maki DG, Weise CE, Sarafin HW (1977) A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 296:1305–1309

    PubMed  CAS  Google Scholar 

  19. Mohr-O’Hara CWM, Michael-Miller J (2003) Manual and automated systems for detection and identification of microorganisms. In: Murray PR, Jorgensen JH, Pfaller MA, Yolken RH (eds) Manual of clinical microbiology. American Society for Microbiology, Washington, DC, pp 185–207

    Google Scholar 

  20. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  21. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256

    Article  PubMed  Google Scholar 

  22. Ruhe JJ, Menon A (2006) Clinical significance of isolated Staphylococcus aureus central venous catheter tip cultures. Clin Microbiol Infect 12:933–936

    Article  PubMed  CAS  Google Scholar 

  23. Ekkelenkamp MB, van der Bruggen T, van de Vijver DA, Wolfs TF, Bonten MJ (2008) Bacteremic complications of intravascular catheters colonized with Staphylococcus aureus. Clin Infect Dis 46:114–118

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Thomas O’Boyle for his help in the preparation of the manuscript and José María Bellón (Unit of Statistics and Epidemiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain) for statistical assistance. Financial support: Alfonso Pérez Parra MD is contracted by the Fundación para la Investigación Biomédica del Hospital General Universitario Gregorio Marañón and Fondo de Investigación Sanitaria (FIS) CM06/00037. Jesús Guinea is contracted by the Fundación para la Investigación Biomédica del Hospital General Universitario Gregorio Marañón and Fondo de Investigación Sanitaria (FIS) CM05/00171. Patricia Muñoz and Emilio Bouza collaborate with the Red Española de Investigación en Patología Infecciosa (REIPI), RD06/0008/1025.

Conflict of interest statement

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

    Alfonso Pérez-Parra, Patricia Muñoz, Jesús Guinea, Pablo Martín-Rabadán, María Guembe & Emilio Bouza

  2. CIBER de Enfermedades Respiratorias (CIBER RES), CD06/06/0058, Palma de Mallorca, Spain

    Patricia Muñoz, Jesús Guinea & Emilio Bouza

  3. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario “Gregorio Marañón”, C/. Dr. Esquerdo, 46, 28007, Madrid, Spain

    Alfonso Pérez-Parra

Authors
  1. Alfonso Pérez-Parra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Muñoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jesús Guinea
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pablo Martín-Rabadán
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. María Guembe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emilio Bouza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alfonso Pérez-Parra.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-009-1432-5.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pérez-Parra, A., Muñoz, P., Guinea, J. et al. Is Candida colonization of central vascular catheters in non-candidemic, non-neutropenic patients an indication for antifungals?. Intensive Care Med 35, 707–712 (2009). https://doi.org/10.1007/s00134-009-1431-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-009-1431-6

Keywords

Search

Navigation