Abstract
Background
By IDSA guidelines, therapy for central line-associated bloodstream infections (CLABSI) due to Candida species requires catheter removal and administration of systemic antifungals. Despite this, in selected cases catheter salvage is desirable. The addition of antifungal lock therapy (ALT) has been proposed in these cases, but evidence for efficacy of this approach is limited. Here we report a retrospective analysis of ALT use for CLABSI due to Candida species at a single pediatric center.
Methods
All events of candidal CLABSI with ALT use were identified by retrospective record review between January 1, 2008 and December 31, 2018. CLABSI was defined by the growth of Candida from at least one central blood culture. Clearance was defined as a period of 48 hours with no positive cultures. Recurrence was defined as a subsequent positive blood culture with the same fungal organism either before or after line removal. Events were classified as “early removal” vs. “retained 7 days” depending on whether the line remained in place on day 7 after the first positive culture.
Results
Overall, 122 qualifying CLABSI were identified, 64 (52%) were retained 7 days or more (Table 1). Overall, 59% of CLABSI met criteria for clearance prior to line removal. Lines retained 7 days were likely to also remain in place at 28 days (72%) and had a low rate of relapse (8%) within 28 days. Lines in the early removal group had lower recurrence rates within 1 year (17% vs. 42%, P = 0.005), but this difference narrowed when considering recurrence at any time (31% vs. 47%, P = 0.1) or by Kaplan–Meier analysis (Figure 1) Additional microbiological and outcome data can be found in Tables 2 and 3.
Conclusion
This retrospective analysis is the largest described cohort of antifungal locks for line salvage in a pediatric population to our knowledge. These findings highlight the advantages of line removal, with lower recurrence at 1 year. However, when line salvage with antifungal locks is attempted, retention and recurrence rates in the first month are favorable, and recurrence rates converge in the long-term, presumably because the underlying risk factors remain. While line removal remains the standard therapy for candidal CLABSI, we find that ALT-based line salvage may be a viable alternative.
Disclosures
All Authors: No reported Disclosures.
Reasons for Failure of Antifungal-lock Therapy with Caspofungin: Need for Higher Concentrations
