High rate of Candida deep-seated infection in patients under chronic hemodialysis with extended central venous catheter use

Background: Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure. Aims: The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare associated infection. Methods: We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48 h of hospital admission. Results: We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%). Conclusions: CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality. (C) 2016 Asociacion Espafiola de Micologia. Published by Elsevier Espatia, S.L.U. All rights reserved. (AU)