PubMed · 9562800
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A B Macura. 1997. [Candidiasis: an unrecognized problem].. https://pubmed.ncbi.nlm.nih.gov/9562800/
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The removal of all central venous catheters (CVCs) from all patients with candidemia is considered to be standard care. However, this practice is not always possible, and it is associated with significant cost and potential complications. To evaluate the effect of CVC removal on the outcome of patients with candidemia, a literature review was conducted that selected studies that evaluated CVC removal as a prognostic factor (of mortality) in candidemia, performed a multivariate analysis with odds ratios and 95% confidence intervals, and included a validated severity of illness score. Of 203 studies of candidemia, only 4 fulfilled these criteria. One study showed a benefit from CVC removal in a subset of 21 neutropenic patients; another study showed no benefit; and the remaining 2 studies showed a marginal benefit from this strategy. Although it is possible that removal of CVCs may reduce the rate of complications due to candidemia, including death, the findings of this literature review do not substantiate this consensus recommendation.
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OBJECTIVE: To determine if the presence of candidemia in infants is associated with an increased incidence of threshold retinopathy of prematurity (ROP). DESIGN: Retrospective, case-controlled study. PARTICIPANTS AND CONTROLS: Forty-six infants admitted to the Texas Children's Hospital Neonatal Intensive Care Unit between 1989 and 1999 with a birth weight 1500 g or less, estimated gestational age (EGA) 28 weeks or less, and in whom candidemia developed were matched to a control group of 46 infants based on corresponding birth weight, EGA, and year of birth. METHODS: Records of each infant were reviewed to determine the presence and severity of ROP. MAIN OUTCOME MEASURES: Development of threshold ROP, including retinal detachment. RESULTS: Forty-three infants (93.5%) with candidemia and 39 (84.8%) without candidemia had ROP. Twenty-four infants (52.2%) with candidemia reached threshold and required surgical intervention, compared with 11 infants (23.9%) without candidemia (adjusted odds ratio [OR], 7.4; 95% confidence interval [CI], 1.7-32.1; P = 0.008). Retinal detachment developed in 10 of 24 candidemic infants (41.7%) who reached threshold ROP, compared with 2 of 11 infants (18.2%) without candidemia (OR, 4.4; 95% CI, 0.73-26.9; P = 0.1). CONCLUSIONS: Candidemia is associated with increased risk of threshold ROP. Infants with Candida sepsis should be monitored closely for the development of ROP and progression after treatment.