Does Catheter Removal not Matter in Candidemia Patients?

To the Editor We read with interest the recent manuscript that described a study about the epidemiology and predicting factors of candidemia in Chinese hospitals (1). The difference between the mortality in an ICU setting and that in a non-ICU setting was very impressive. However, we are concerned about the low rate (48.3%) of catheter removal in candidemia patients. The authors also referred to this point in the discussion. In other recent studies (2, 3), central venous catheter removal, particularly in the early phase, was a highly protective factor in a patient’s survival, although negative results have also been published (4). In the study by Li et al. (1), a central venous catheter was placed in most ICU patients [83.8% (67/80)], and the authors concluded that the 90-day mortality rate was higher in the ICU than in the non-ICU setting (52.5% vs. 36.7%). The statistical difference in the mortalities of the two groups would change according to the prevalence of patients who must have a catheter removed. The Infectious Diseases Society of America guideline recommends the removal of central venous catheters (5), and the issue of whether or not catheter removal is a protective factor has been well discussed (2-4) in previous reports. In addition, the authors have the catheter removal rate data. We recommend that the authors show the item “catheter removal” to their retrospective analysis.