Should central venous catheters be removed as soon as candidemia is detected in neonates
Abstract
Background Controversy exists regarding the most appropriate acute management of central venous catheters (CVCs) in neonates with candidemia, with up to two thirds of neonatologists preferring to attempt antifungal therapy without removing CVCs. Objective To determine whether CVCs should be removed as soon as candidemia is detected in neonates. Methods. A cohort study of candidemia and CVC was conducted in infants in a neonatal intensive care unit (NICU) over a 5-year period (1994-1998). Results Fifty infants had early-removal CVC (ER-CVC) within 3 days and 54 infants had late-removal CVC (LR-CVC) >3 days after the first positive blood culture for Candida species. All infants were treated with amphotericin B. There was no significant difference between infants in the ER-CVC and LR-CVC groups in terms of gender, ethnicity, birth weight, gestational age, age at candidemia, severity-of-illness scores, distribution of types of CVC, or in the distribution of Candida species causing candidemia. The ER-CVC group had significantly shorter duration of candidemia (median: 3 days; range: 1-14 days), compared with the LR-CVC group (median: 6 days; range: 1-24 days). The case fatality rate of Candida albicans candidemia was significantly affected by the timing of CVC removal: 0 of 21 (95% confidence interval [CI]: 0-14) infants died in the ER-CVC group in contrast to 9 of 23 (39%; 95% CI: 19-59) in the LR-CVC group. Conclusion Failure to remove CVC as soon as candidemia was detected in ne…
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Catheter removal is associated with reduced mortality in adults and neonates with candidemia.
“includes data in which catheter removal was associated with reduced mortality in adults [108, 116] and neonates [117].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [117]
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- Authors
- Karlowicz, M. G., Hashimoto, L. N., Kelly, R. E., & Buescher, E. S.
- Affiliations
- From the Departments of Pediatrics and
- Eastern Virginia Medical School (US)
- ORCID
- Kelly, Robert E.
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2000-11-01
- Volume
- 106
- Issue
- 5
- Pages
- e63-e63
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2057232181
- Cited by
- 178
- References
- 17
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 5 · 2015: 7 · 2014: 8 · 2013: 11 · 2012: 8
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Keywords
- candidemia, central venous catheters, neonates, catheter removal timing, Candida albicans, amphotericin B, case fatality rate, neonatal intensive care, antifungal therapy
- MeSH terms
- Candida, Candidiasis, Catheterization, Central Venous, Humans, Infant, Newborn, Intensive Care Units, Neonatal
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