カンジダ菌血症でCVカテーテルを早期に抜去しても予後は改善しない

　カンジダ菌血症candidemiaの患者は、中心静脈カテーテルcentral venous catheter (CVC)を、早期に抜去することが、標準的なケアとなっています。しかし、早期の交換（24時間）は、多変量解析で予後改善を示せなかったという報告。

　842名のカンジダ菌血症の患者を、24時間後と48時間後で治療上の成功、生存率（28日目,42日目）などで比較。

　単変量解析の結果、微生物学的な菌の撲滅、感染の持続率やカンジダ菌血症の再発については、改善をしなかったが、治療的な成功と生存については関連性があった。しかし、これらの有効性は多変量解析では確認ができなかった。

Clin Infect Dis. 2010 Aug 1;51(3):295-303.

Early removal of central venous catheter in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical trials.

BACKGROUND: Patients with candidemia frequently have a central venous catheter (CVC) in place, and its early removal is considered the standard of care.

METHODS: We performed a subgroup analysis of 2 phase III, multicenter, double-blind, randomized, controlled trials of candidemia to examine the effects of early CVC removal (within 24 or 48 h after treatment initiation) on the outcomes of 842 patients with candidemia. Inclusion criteria were candidemia, age >16 years, CVC at diagnosis, and receipt of 1 dose of the study drug. Six outcomes were evaluated: treatment success, rates of persistent and recurrent candidemia, time to mycological eradication, and survival at 28 and 42 days. Univariate and multivariate analyses were performed, controlling for potential confounders.

RESULTS: In univariate analysis, early CVC removal did not improve time to mycological eradication or rates of persistent or recurrent candidemia but was associated with better treatment success and survival. These benefits were lost in multivariate analysis, which failed to show any beneficial effect of early CVC removal on all 6 outcomes and identified Acute Physiology and Chronic Health Evaluation II score, older age, and persistent neutropenia as the most significant variables.

Our findings were consistent across all outcomes and time points (removal within 24 or 48 h and survival at 28 and 42 days).

The median time to eradication of candidemia was similar between the 2 study groups.

CONCLUSIONS: In this cohort of 842 adults with candidemia followed up prospectively, early CVC removal was not associated with any clinical benefit. These findings suggest an evidence-based re-evaluation of current treatment recommendations.

これから）職責者会議、技術職員の面接２名、医療安全委員会。先週末の日病薬の関ブロには多くの方々にポスター発表にお越しいただき、ありがとうございました！