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Tuesday, September 30, 2014
Candida infection ?
If the femoral double lumen catheter tip (for haemodialysis)culture showed Candida, but the patient had no fever and not septic looking. Blood culture showed no growth. The femoral line was removed already. Would you recommend antifungal treatment for that? How often would you suggest for the change of the central catheter if there is no evidence of infection?
Regarding bloodstream infections, the U.S. Center for Disease Control and Prevention (CDC) does not recommend routine change of central vascular catheters as a strategy to prevent bloodstream infections. This, along with other recommendations, can be found in the "Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2002" published by the CDC in MMWR Recommendations and Reports, Volume 51, Number RR-10, and also available at the following website http://www.cdc.gov/ncidod/hip/iv/iv.htm The Division of Healthcare Quality Promotion (DHQP) of the CDC also provides information about prevention transmission of infections in dialysis. The DHQP home page is available at this web site http://www.cdc.gov/ncidod/hip/ ...and, specific recommendations and information regarding dialysis are available at this web site http://www.cdc.gov/ncidod/hip/Dialysis/dialysis.htm There is difference of opinion among experts as to whether intravascular catheter-related Candida isolation (from either bloodstream and/or vascular device) requires additional treatment with antifungal agents. Use of symptomatology is always an important aspect in clinical care; however, there are certain medical conditions that reduce the ability of the body to respond symptomatically to infections. There is medical literature supporting that removal of the Candida-affected device (either infected or colonized) alone may be sufficient therapy; this option is paired with an intimate knowledge of the individual patient's other underlying medical conditions that might affect the ability of the body to respond to Candida infection. There are experts who would recommend empiric therapy with antifungal agents. There are some experts who would wish to know the species of Candida organism before recommending a final treatment option; certain species of Candida are more virulent than others. Should treatment with antifungal agents be chosen as an option, the underlying renal function of the patient needs to be known; patients with haemodialysis catheters presumably have decreased renal function which would dictate dose adjustment of many antifungal therapy regimens.
Stephen Kralovic, MD
College of Medicine
University of Cincinnati