Central Line-Related Candida glabrata Fungemia: Diagnostic Performance of Time-To-Reporting of Positive Blood Cultures

Abstract

Background Background: Central venous catheter (CVC) removal is beneficial in patients with CVC-related candidemia, defined as a higher colony count in a catheter lumen, compared to peripheral blood. However, clinicians are often faced with a blood culture growing Candida in a patient with a CVC, and few laboratories perform quantitative cultures. Therefore, it was proposed that short time-toculture positivity (TTP) can be suggestive of catheter-related candidemia, in series of predominantly C. albicans candidemia episodes. Given the epidemiologic shift to non-albicans Candida species, and the longer time to detection for C. glabrata, compared to other Candida species, we studied the clinical characteristics of patients with CVC-related C. glabrata fungemia and the diagnostic utility of time-to-reporting (TTR) of positive blood cultures. Methods: We included patients with ≥1 blood culture(s) positive for C. glabrata, a CVC and available TTR, seen at M.D. Anderson Cancer Center between 3/2005-9/2013. CVC-related candidemia was defined as a colony count in a blood culture obtained via the CVC at least fivefold greater than the colony count in peripheral blood. Results: Fifty-six of 115 patients studied (49%) were deemed to have CVC-related candidemia. Those patients were less likely to be on total parenteral nutrition (TPN, 34[61%] vs. 48[81%] of those with non-CVC-related candidemia, P=0.01), or have an absolute neutrophil count <100/μL (2[4%] vs. 13[22%], P<0.01). TTR was shorter in patients with CVC-related candidemia (mean ± standard deviation, 67±35 hours) compared to those with non-CVC-related candidemia (79±31 hours, P<0.01), and had significant diagnostic value by ROC analysis. A TTR <48 hours was 99% specific for CVC-related candidemia. Conclusions: Among patients with C. glabrata fungemia, an abdominal source was more likely than CVC-related candidemia in severely neutropenic patients and in those receiving TPN. In the evaluation of patients with C. glabrata fungemia, a TTR of <48 hours could further support the decision to remove the CVC.