Catheter-Related Candidemia: What You Need to Know About This Hidden Risk
"Understanding the causes, risks, and prevention of candidemia in cardiovascular patients. Plus, the latest on non-albicans Candida infections."
In recent decades, the landscape of nosocomial fungal infections has seen a significant shift, driven by the increasing use of medical devices and technologies. This rise is particularly evident in developing countries and, indeed, within Iran. Among those at heightened risk are individuals with heart failure, where the intersection of cardiac disease and candidiasis presents a complex challenge.
Candidemia, a bloodstream infection caused by Candida species, is a major concern for hospitalized patients, especially those in intensive care units (ICUs) and coronary care units (CCUs). Several risk factors contribute to this increased susceptibility, including prolonged ICU stays, the use of central venous catheters (CVCs), broad-spectrum antibiotic treatments, glucocorticoid use, parenteral nutrition, and invasive surgical procedures such as cardiac valve repair or replacement.
While venous catheters offer essential benefits in patient care, they can also inadvertently create pathways for fungal agents to colonize and cause infections. These infections can range from localized issues and venous inflammation to, in rare instances, the systemic spread of infection. Given the severity and potential complications of invasive candidiasis, early detection and appropriate management are critical.
What is Catheter-Related Candidemia and Why Is It a Concern?
Catheter-related bloodstream infections (CRBSIs) are among the most dangerous complications associated with vascular catheters. These infections not only increase healthcare costs and extend hospital stays but also significantly elevate patient mortality rates, especially within intensive care units. Candida species, a type of yeast, are a common cause of CRBSIs, leading to a condition known as catheter-related candidemia.
- Study Design: Researchers collected 223 samples from patients admitted to the Tehran Heart Center over 18 months.
- Sampling Methods: Both blood and catheter cultures were performed to detect fungal elements. Polymerase chain reaction (PCR) was used to identify Candida species.
- Findings: 15 yeast isolates were identified, with 60% from catheter cultures, 26.6% from blood cultures, and 13.4% from skin cultures at the catheter insertion site.
- Species Identification: Candida albicans and Candida glabrata were the most common species. C. tropicalis and C. membranifaciens were also identified in catheter and blood cultures.
- Confirmed Cases: Two cases of catheter-related candidemia were confirmed based on genetic similarity between Candida species isolated from blood and catheter samples. These cases were successfully treated with fluconazole and catheter removal.
What's the takeaway?
The study underscores the growing prevalence of non-albicans Candida infections and the importance of identifying the source of infection in candidemia cases. Positive blood and catheter cultures, combined with genetic similarity of Candida isolates, confirm the diagnosis of intravenous catheter-related candidemia. Early detection and appropriate treatment, including catheter removal and antifungal medications, are essential for successful outcomes.