633. Liposomal Amphotericin Lock Therapy for Catheter-Associated Candidemia: a Case Control Study
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Catheter related bloodstream infections (CRBSI) are a growing problem in pediatric patients. Previous guidelines however have emphasized removal of catheters with candidal infections.  We have used liposomal amphotericin (LAB-ALT) for antibiotic lock therapy in cases of catheter-associated candidemia since 2006, for catheters where salvage is a high priority and the risk of treating with the infected line in place are understood.  We undertook a retrospective case control review of our experience with LAB-ALT to examine its efficacy in conjunction with systemic therapy in patients with persistent candidal CRBSI.

Methods: Electronic records were reviewed for patients with persistent CRBSI at CHP from 1/2004 – 3/2010, with or without LAB-ALT.  Patient demographics, antibiotics, blood culture results and relapse of infection up to 28 days after completion of therapy were recorded.  Clearance of initial infection, retention of catheter during therapy, and no relapse 28 days after completion of therapy were the main endpoints.

Results: A total of 28 episodes of candidal CRBSI treated with LAB-ALT and 30 episodes treated with standard therapy (no ALT) were studied, with mean duration of candidemia = 4.6 days in both groups.  The predominant organisms were C. albicans and C. tropicalis (66% LAB-ALT and 45% no ALT) in both groups, while C. glabrata was more common in the no ALT group (30% versus 10% ).  More patients in the LAB-ALT group had short bowel syndrome or solid organ transplant (82.5% versus 46%).  LAB-ALT was superior in clearing initial infection (74% versus 30% of no ALT cases, p <0.001), with relapse at <28 days being unusual (6% and 4%).  LAB-ALT was superior in all CRBSI in salvaging catheters without removal and preventing relapse at <28 days (42% versus 20%, p = 0.05).  Oncology patients had the least success (0% in all groups for overall outcome), while short bowel patients fared best (42% overall success versus 28% for no ALT).  No significant differences in toxicity were noted between with 2 groups.

Conclusion: LAB-ALT is safe and effective in children with CRBSI, and is associated with improved retention of catheters and clearance of persistent infections.  These data support the IDSA recommendation for use in candidal CRBSI, even in persistent cases.


Subject Category: A. Antimicrobial agents and Resistance

Speakers:
Andrew Nowalk, MD, PhD , Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA

Disclosures:

A. Nowalk, None

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