Clinical significance of Candida colonization of intravascular catheters in the absence of documented candidemia☆ , ☆☆ , ★ Francisco López-Medrano a, 1 , Mario Fernández-Ruiz a, ⁎ , 1 , Julia Origüen a , Laia C. Belarte-Tornero a , Raquel Carazo-Medina a , Fernando Panizo-Mota a , Fernando Chaves b , Francisca Sanz-Sanz b , Rafael San Juan a , José María Aguado a a Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación “Hospital 12 de Octubre” (i+12), Universidad Complutense, Madrid, Spain b Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación “Hospital 12 de Octubre” (i+12), Universidad Complutense, Madrid, Spain abstract article info Article history: Received 14 January 2012 Received in revised form 3 March 2012 Accepted 5 March 2012 Available online 5 April 2012 Keywords: Bloodstream infection Candida spp. Central venous catheter Intravascular catheter Outcome Tip culture In order to assess the significance of Candida colonization of intravascular catheters (IVC) in patients without documented candidemia, we retrospectively reviewed all Candida-positive IVC tip cultures over a 4-year period. Cases were defined as those with a culture yielding ≥15 colony-forming units of Candida spp. that either did not have blood cultures (BC) taken or had concomitant BC negative for Candida. Patients were followed up until death or 8 months after discharge. Risk factors for poor outcome following IVC removal (death, candidemia, or Candida-related complication) were analyzed. We analyzed a total of 40 patients. Overall mortality was 40.0%, with no death directly attributed to Candida infection. Twenty-two patients received antifungal therapy at the time of IVC removal. Only 1 patient developed a metastatic complication (chorioretinitis) attributable to transient candidemia (2.5% of the global cohort and 3.7% among those with concomitant BC). There were no cases of subsequent candidemia. In the multivariate analysis, the use of antifungal therapy did not show any impact on the risk of poor outcome. The risk of invasive disease in patients with isolated IVC colonization by Candida seems to be low. Nevertheless, the initiation of systemic antifungal therapy should be carefully considered in such context. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Candida species has emerged as the fourth leading cause of healthcare-associated bloodstream infections over the last few decades (Edmond et al., 1999), posing a major challenge as a result of the increased use of invasive procedures and immuno- suppressive therapies. A population-based surveillance for Candida bloodstream infections performed in Barcelona (Spain) revealed an overall incidence of 0.53 cases per 1000 hospital discharges, with 89% of patients having a central venous catheter (CVC) at diagnosis (Almirante et al., 2005). The demonstration of intra- vascular catheter (IVC) tip colonization is one of the criteria required to establish the definitive diagnosis of catheter-related bloodstream infection (CRBSI) (Mermel et al., 2009). The Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of IVC-related infection recommend, in their latest update, that tip cultures should be only done when a catheter is removed because of suspected CRBSI and advise against its routine processing (Mermel et al., 2009). However, it is not unusual in clinical practice to encounter a positive culture for Candida spp. from an IVC tip in patients with negative concomitant blood cultures taken at the time of removal, or for whom no blood cultures have been obtained. The significance in daily clinical practice of this finding remains difficult to interpret, with somewhat contradictory results in previous studies (Bach, 1995; Khatib et al., 1995; Park et al., 2010; Pérez-Parra et al., 2009). In fact, the IDSA guidelines identify this situation as an unresolved issue in the management of CRBSI (Mermel et al., 2009). Given these uncertainties, we conducted this retrospective study to evaluate the current therapeutic approaches and subsequent outcome in noncandi- demic patients with isolated Candida spp. IVC tip cultures, paying specific attention on the impact of the administration of antifungal therapy in this subgroup. Diagnostic Microbiology and Infectious Disease 73 (2012) 157–161 ☆ Funding sources: Francisco López-Medrano has received a grant from Fundación Mutua Madrileña. Mario Fernández-Ruiz holds a research training contract “Rio Hortega” (CM11/00187) from the Spanish Ministry of Economy and Competitiveness (Instituto de Salud Carlos III). ☆☆ This study was partially presented at the 15th Congress of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Málaga, Spain (June 1–4, 2011) [poster 266]. ★ Transparency declaration: The authors have no conflicts of interest. ⁎ Corresponding author. Tel.: +34-91-3908000; fax: +34-91-4695775. E-mail address: mario_fdezruiz@yahoo.es (M. Fernández-Ruiz). 1 Both authors contributed equally to this work. 0732-8893/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.diagmicrobio.2012.03.002 Contents lists available at SciVerse ScienceDirect Diagnostic Microbiology and Infectious Disease journal homepage: www.elsevier.com/locate/diagmicrobio