Program Schedule

1440
Central Venous Catheter Retention and Mortality in Children with Candidemia: A Retrospective Cohort Analysis

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Candidemia causes significant morbidity and mortality among hospitalized children.  Prompt removal of a central venous catheter (CVC) is often recommended for adults with candidemia to decrease the likelihood of persistent and metastatic infection, but pediatric specific data are limited. We investigated the association of CVC retention and 30-day all cause mortality in a pediatric specific cohort.

Methods: We performed a retrospective cohort study of inpatients (age 0 to <19 years) with candidemia at the Children’s Hospital of Philadelphia between 2000 and 2012 who had survived and retained their CVC at least one day beyond the blood culture being positive for yeast. A structured data collection instrument was used to retrieve clinical and laboratory data. A discrete time failure model was used to assess the association of CVC retention and 30-day all cause mortality. CVC exposure was not considered until the day after the culture was known to be positive for a Candida species. We adjusted for age and the complexity of clinical care prior to onset of candidemia. Complexity of clinical care included recent exposure to immune suppressive agents, recent requirement for parenteral nutrition, and admission to the ICU at time of blood culture. 

Results: Of the 436 incident cases of candidemia, 289 (64%) had a CVC in place at the time of blood culture and survived at least one day after candidemia onset. Among these 289 patients, 30 (10%) died within 30 days of candidemia diagnosis. CVC retention was significantly associated with an increased risk of death on a given day (OR: 2.53, 95% CI: 1.07 to 5.98). 

Conclusion:

Retention of a CVC was associated with an increased risk of death after adjusting for age and complexity of care at candidemia onset. These results need to be interpreted with caution, as there is likely persistence of unmeasured confounding. However, given the negative association between catheter retention and death, our data suggest that early CVC removal should be strongly considered in pediatric patients with candidemia.

Brian Fisher, DO, MPH, MSCE1,2, Neika Vendetti, MPH3, Matthew Bryan, PhD4, Priya Prasad, MPH5, A. Russell Localio, PhD6, Charalampos Gousis, MD7, Andreas Damianos, MD1, Susan E. Coffin, MD, MPH8, Robert Gross, MD, MSCE9 and Theoklis Zaoutis, MD, MSCE3, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Center for Clinical Epidemiology & Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (3)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, the Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, (5)Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, (6)University of Pennsylvania School of Medicine, Philadelphia, PA, (7)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, (8)Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (9)The University of Pennsylvania, Philadelphia, PA

Disclosures:

B. Fisher, None

N. Vendetti, None

M. Bryan, None

P. Prasad, None

A. R. Localio, None

C. Gousis, None

A. Damianos, None

S. E. Coffin, None

R. Gross, None

T. Zaoutis, Merck: Investigator, Research grant
Merck: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee
Astellas: Consultant, Consulting fee

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