Should central venous catheters be removed as soon as candidemia is detected in neonates?

Background. Controversy exists regarding the most appropriate acute managem ent of central venous catheters (CVCs) in neonates with candidemia, with up to two thirds of neonatologists preferring to attempt antifungal therapy w ithout removing CVCs. Objective. To determine whether CVCs should be removed as soon as candidemi a is detected in neonates. Methods. A cohort study of candidemia and CVC was conducted in infants in a neonatal intensive care unit (NICU) over a 5-year period (1994-1998). Results. Fifty infants had early-removal CVC (ER-CVC) within 3 days and 54 infants had late-removal CVC (LR-CVC) >3 days after the first positive bloo d culture for Candida species. All infants were treated with amphotericin B . There was no significant difference between infants in the ER-CVC and LR- CVC groups in terms of gender, ethnicity, birth weight, gestational age, ag e at candidemia, severity-of-illness scores, distribution of types of CVC, or in the distribution of Candida species causing candidemia. The ER-CVC gr oup had significantly shorter duration of candidemia (median: 3 days; range : 1-14 days), compared with the LR-CVC group (median: 6 days; range: 1-24 d ays). The case fatality rate of Candida albicans candidemia was significant ly affected by the timing of CVC removal: 0 of 21 (95% confidence interval [CI]: 0-14) infants died in the ER-CVC group in contrast to 9 of 23 (39%; 9 5% CI: 19-59) in the LR-CVC group. Conclusion. Failure to remove CVC as soon as candidemia was detected in neo nates was associated with significantly increased mortality in C albicans c andidemia and prolonged duration of candidemia regardless of Candida specie s.