Impact of early catheter removal during treatment of invasive candidiasis: analysis from two phase 3 micafungin trials

Introduction

Prompt central venous catheter (CVC) removal is often recommended in candidemic patients [1, 2]. To investigate further, we evaluated relationships between CVC status and 28-day and 42-day survival post-treatment initiation, overall treatment success, and time to mycological eradication.

Methods

Data from two randomized, double-blind, phase 3 mica-fungin trials evaluating treatment of candidemia and invasive candidiasis (n = 842) were analysed. Univariate analysis was performed to evaluate: associations of baseline CVC removal within 24 hours (CVC24) and 48 hours (CVC48) versus non-removal with each treatment outcome; and associations of potential confounding factors with treatment outcomes. A final multivariate analysis was performed on those associations with P ≤ 0.10.

Results

Univariate analysis revealed that CVC24 was associated with 28-day survival (P = 0.05) and 42-day survival (P = 0.05), and CVC48 with 28-day survival (P = 0.01), 42-day survival (P = 0.01), and overall treatment success (P = 0.02). Neither CVC24 nor CVC28 were associated with time to mycological eradication. After controlling for confounding variables such as baseline Candida species, APACHE II score, underlying disease, and so on, multivariate analysis revealed that neither CVC24 nor CVC48 were statistically significant prognostic indicators for 28-day and 42-day survival (Figure 1). In addition, CVC48 was not associated with overall treatment success.

Figure 1

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Conclusion

Early CVC removal (within 48 hours of treatment start) had no statistically significant effect on treatment success or survival during treatment of invasive candidiasis.