CANDIDAEMIA IN AN AUSTRALIAN TEACHING HOSPITAL - RELATIONSHIP TO CENTRAL LINE AND TPN USE

We performed a retrospective review of patient case records to identif y risk factors for candidaemia and to assess incidence, management and outcome of candidaemia in an Australian teaching hospital, Between Ja nuary 1994 and lune 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 e ight of 13 (62%) of these deaths attributable to candidaemia. Risk fac tors included underlying gastrointestinal disease (66%) and recent abd ominal 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 sou rce of candidaemia in 28 (97%), Twenty-six (90%) were being used for T PN administration, Of patients receiving TPN, 5.2% developed candidaem ia. Standard central venous catheters (CVC) were present in 21 patient s (55%), having been in situ for an average of 12.7 days. Eighteen (86 %) had been in situ for 7 days or more, Management inolved removal of any implicated intravascular device. Thirty of 33 early survivors rece ived antifungal chemotherapy. Therapy with amphotericin B, fluconazole alone or amphotericin B followed by fluconazole was equally effective . Concurrent corticosteroid use and neutropaenia contributed to increa sed mortality. Candidaemia is not benign, Policies regarding regular c hanging of central lines, especially in the setting of TPN administrat ion and control of broad spectrum antibiotic use are appropriate measu res aimed to reduce incidence. Management involves removal of implicat ed lines and antifungal chemotherapy. Pre-emptive therapy for candida infection should be considered in selected patients with the likelihoo d of TPN-related central line sepsis. Fluconazole is an effective alte rnative to amphotericin B in non-neutropenic patients.