2012 Volume 27 Issue 1 Pages 8-12
Catheter-related Candida bloodstream infection (CR-BSI) is difficult to treat, especially in patients with refractory complications such as Candida endophthalmitis. In our hospital, the infection control team (ICT) is conducting surveillance of all blood culture-positive cases. From the database of all samples of positive blood culture in this hospital, we examined all CR-BSI cases involving intravascular catheters newly inserted from April 2008 to September 2010 to analyze the primary causative organism, the background factors, and the ICT intervention for coexisting illness. A total of 72 CR-BSI cases occurred during the investigation period, including 28 cases of Candida infection, and 44 cases of bacterial infection. Three background factors were significant in the Candida infection group: duration of hospitalization of more than 4 weeks, receiving total parental nutrition, and administration of broad spectrum antibiotics within the past four weeks. Furthermore, the proportion of patients with two or more such factors was significantly high in the Candida group. The period before initial treatment was 1.5±0.6 days for the bacterial group and 2.7±0.7 days for the Candida group (p<0.01). Five patients had Candida endophthalmitis. There was no significant difference in the period before appropriate treatment between the endophthalmitis group and the other group. Interventions were made by the ICT in 20 of the 28 cases (71%). There was no significant difference in the period before treatment between the intervention group and the other group. The ICT has intervened as soon as the blood culture was positive so far. However, this study suggests that we should consider starting antimycotic therapy to reduce the complications and the delay for initial treatment in patients with high risk of Candida infection.
