ABSTRACT
INTRODUCTION The use of indwelling medical devices (e.g., central venous catheters; CVCs) in current therapeutic practice has been found to be responsible for more than 80% to 90% of hospital-acquired bloodstream and deep tissue infections (1). Transplantation procedures, immunosuppression, and prolonged intensive care unit stays have also increased the prevalence of nosocomial, especially fungal infections. Candida spp. are the most commonly associated fungal organisms with such nosocomial infections, with Candida albicans being the most common species causing both superficial and systemic diseases. Even with current antifungal therapy, mortality associated with invasive candidiasis due to nosocomial infections can be as high as 40% in adults (2,3) and up to 30% in the neonate population (4). In a multicenter study of 427 consecutive patients with candidemia, the mortality rate for patients with catheter-related candidemia was found to be 41% (5). Candida infections are often associated with indwelling medical devices such as dental implants, catheters, heart valves, vascular bypass grafts, ocular lenses, artificial joints, and central nervous system shunts, and commonly involve biofilm formation. Forty percent of patients with microbial colonization of intravenous catheters develop occult fungemia, with consequences ranging from focal disease to severe sepsis and death (5,6). The tenacity with which Candida infects indwelling biomedical devices necessitates their removal to effect a cure. For candidemia-associated nontunneled CVCs, initial management includes exchanging of catheter and performing semiquantitative or quantitative catheter cultures (7), and the InfectiousDiseases Society ofAmerica (IDSA) guidelines suggest that antifungal therapy is necessary in all cases of vascular catheter-related candidemia (8). Catheter-related bloodstream infections (CRBSIs) commonly involve colonization of microorganisms on catheter surfaces where they eventually become embedded in a biofilm (9).
