Patient selection: presence of cancer, central venous catheter and candidemia
Criteria for possible central venous catheter related candidemia - one or more of the following:
(1) ratio of (CFU from quantitative culture of blood culture drawn from CVC) to (CFU from simultaneously drawn peripheral blood culture) >= 5:1
(2) time to positivity for culture of blood culture drawn from CVC >= 2 hours sooner than time to positivity for a culture simultaneously drawn peripheral blood culture (time for peripheral culture - time for central culture >= 2 hours)
(3) AND (all of the following)
(3a) no chemotherapy within 1 month prior to onset of candidemia
(3b) no corticosteroids given within 1 month prior to candidemia
(3c) no evidence of disseminated candidemia
where:
• CFU = colony forming units on yeast culture
• The first 2 items are the microbiological indicators while the final criterion represents the clinical indicators.
• The wording of the 3rd criterion may cause problems during implementation since it can involve a double negative.
General management (considered CVC-related or not):
(1) Start antifungal therapy.
(2) If the person responds within 72 hours then continue antifungal therapy.
(3) If the person does not respond within 72 hours then consider alternative infection site (endocarditis, septic thrombus, etc.)
(4) If the person does not respond within 72 hours then re-evaluate choice of antifungal regimen.
If the candidemia is CVC-related then the catheter is removed early.
If the candidemia is not CVC-related then the catheter is left in place. It is removed if the patient is not improved within 72 hours after starting antifungal therapy.
