Abstract
Background
Candidaemia is an important nosocomial infection, seen frequently in immunocompromised and critically ill patients and increasingly recognised in cystic fibrosis (CF) patients with totally implantable venous access devices (TIVADs). This study aims to investigate the incidence and risk factors for the development of TIVAD-associated candidaemia and to assess the rate of TIVAD-related complications in CF patients.
Methods
A 10-year retrospective study was carried out on adult CF patients attending a single centre. Complications were recorded including the incidence of candidaemia and correlated to clinical parameters. Complication rates were calculated based on incidence per 1000 catheter days. Statistical analysis was performed using Mann-Whitney U test and Fisher’s exact test.
Results
Fourteen cases of candidaemia were observed in the CF cohort, primarily caused by Candida parapsilosis and Candida albicans. Candidaemia was associated with lower FEV1 (p = 0.0117) and higher frequency of pulmonary exacerbation (p < 0.0001). A TIVAD complication rate of 0.337/1000 catheter days was observed in the CF cohort. Complications included venous thrombosis, stenosis, and port extrusion; complications were independently associated with more frequent pulmonary exacerbations (p = 0.04).
Conclusions
TIVAD complications are observed more commonly in those with lower FEV1 and frequent pulmonary exacerbations, suggesting that candidaemia may be related to antibiotic use and furthermore can occur following invasive procedures causing translocation of fungal species allowing transformation from colonisation to pathogenic infection.
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Authors’ contributions
CMcC, OO’C, CG and NGMcE designed the study. The statistical analysis was carried out by CMcC, OO’C and MEO’B. The data collection was conducted by CMcC, OO’C, TMcE and AF. The manuscript was written by CMcC, OO’C, MEO’B, TMcE, AF, CG and NGMcE. CMcC, CG and NGMcE take responsibility for the integrity of the work as a whole, from the inception to the published article.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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The authors declare that they have no conflict of interest.
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McCarthy, C., O’Carroll, O., O’Brien, M.E. et al. Risk factors for totally implantable venous access device-associated complications in cystic fibrosis. Ir J Med Sci 187, 429–434 (2018). https://doi.org/10.1007/s11845-017-1672-2
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DOI: https://doi.org/10.1007/s11845-017-1672-2