D Katz et al. JPGN Reports 4(4):p e358, November 2023. | DOI: 10.1097/PG9.0000000000000358 Open Access! Early Central Venous Catheter Replacement After Candida in Pediatric Intestinal Failure Patients.

Background:

• The Infectious Diseases Society of America (IDSA) recommends the removal of both short- and long-term catheters in patients with catheter-related bloodstream infection (CRBSI) due to fungi (¹). 
• In addition to source control, antifungal treatment and blood culture-confirmed clearance are recommended for all cases of CRBSI due to candida…In contrast, little is known about the optimal timing for the replacement of a CVC in the setting of candidemia (^5–7). As a result, practices greatly vary between practitioners.

Methods: This was a retrospective, single-center review of children with intestinal failure (IF). Patients were divided into early (<7 days after their first negative culture), and late (≥7 days after their first negative culture) CVC replacement following uncomplicated candidemia. 

Key findings:

• Early replacement occurred in 18 encounters and late replacement in 21 encounters. The median time to CVC replacement or exchange in the early group was 4 days, compared to 10 days in the late group (P < 0.001).
• The median duration of the hospitalization in the early group was 12 days compared to 21 days in the late group (P = 0.011).
• None of the patients were reinfected with candida within 30 days.

My take: This small study provides reassurance that earlier replacement of  CVCs after clearance of uncomplicated candidemia is beneficial.

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