Candidaemia in an Australian teaching hospital: Relationship to central line and TPN use

Abstract

We performed a retrospective review of patient case records to identify risk factors for candidaemia and to assess incidence, management and outcome of candidaemia in an Australian teaching hospital. Between January 1994 and June 1996, 38 cases of candidaemia were identified. The incidence was 0.74 per 1000 admissions of 24 h duration, and 1.54 per 1000 admissions of 5 days or more. The mortality rate was 34%, with eight of 13 (62%) of these deaths attributable to candidaemia. Risk factors included underlying gastrointestinal disease (66%) and recent abdominal surgery (61%), while recent broad spectrum antibiotic use was a contributing factor in 95%. Twenty-nine patients (76%) had a vascular access device in situ at time of detection. This was the apparent source of candidaemia in 28 (97%). Twenty-six (90%) were being used for TPN administration. Of patients receiving TPN, 5.2% developed candidaemia. Standard central venous catheters (CVC) were present in 21 patients (55%), having been in situ for an average of 12.7 days. Eighteen (86%) had been in situ for 7 days or more. Management involved removal of any implicated intravascular device. Thirty of 33 early survivors received antifungal chemotherapy. Therapy with amphotericin B, fluconazole alone or amphotericin B followed by fluconazole was equally effective. Concurrent corticosteroid use and neutropaenia contributed to increased mortality. Candidaemia is not benign. Policies regarding regular changing of central lines, especially in the setting of TPN administration and control of broad spectrum antibiotic use are appropriate measures aimed to reduce incidence. Management involves removal of implicated lines and antifungal chemotherapy. Pre-emptive therapy for candida infection should be considered in selected patients with the likelihood of TPN-related central line sepsis. Fluconazole is an effective alternative to amphotericin B in non-neutropenic patients.