Outcome of treatment of candidemia in children whose central catheters were removed or retained.

In this study we reviewed the outcomes of all pediatric patients at Duke University Medical Center between 1978 and 1987 who were treated with amphotericin B and in whom Candida sp. fungemia occurred in the presence of a venous or arterial central catheter. Twenty-one episodes were evaluated for efficacy of either of 2 interventions. In 13 patients the catheter was removed and amphotericin B therapy was begun (Group 1), and in 8 patients, the catheter was retained and amphotericin B therapy was begun (Group 2). Persistent candidemia beyond onset of intervention occurred in 2 of the 13 patients in Group 1 and in 6 of the 8 patients in Group 2 (P = 0.018). In Group 1, 2 of the 13 patients subsequently developed new complications of candidiasis, and no patient died of causes related to candidiasis. In Group 2, 3 of the 8 patients had resolution of persistent candidemia only after catheter removal, 3 developed new complications of candidiasis after initiation of amphotericin B and 2 died with systemic candidal infection. Only one of the catheters initially retained was maintained successfully beyond the second week of amphotericin B therapy. We conclude that adverse outcomes (persistent fungemia, morbidity and mortality) are associated with attempts to maintain central catheters in the presence of candidemia.