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Candidal Suppurative Peripheral Thrombophlebitis Recognition, Prevention, and Management

Published online by Cambridge University Press:  02 January 2015

Thomas J. Walsh
Affiliation:
Division of Infectious Diseases, Veterans Administration Medical Center, University of Maryland Cancer Center, and, University of Maryland School of Medicine, Baltimore, Maryland
Carlos I. Bustamente
Affiliation:
Division of Infectious Diseases, Veterans Administration Medical Center, University of Maryland Cancer Center, and, University of Maryland School of Medicine, Baltimore, Maryland
David Vlahov
Affiliation:
Division of Infectious Diseases, Veterans Administration Medical Center, University of Maryland Cancer Center, and, University of Maryland School of Medicine, Baltimore, Maryland
Harold C. Standiford*
Affiliation:
Division of Infectious Diseases, Veterans Administration Medical Center, University of Maryland Cancer Center, and, University of Maryland School of Medicine, Baltimore, Maryland
*Corresponding
Infectious Diseases Section, Veterans Administration Medical Center, 3900 Loch Raven Boulevard, Baltimore, MD 21218

Abstract

Candida species are seldom considered as a cause of suppurative peripheral thrombophlebitis. During a 15-month period in a 291-bed acute-care hospital, candidal suppurative peripheral thrombophlebitis developed in seven patients. All patients had fever, a tender palpable cord, and Candida species isolated from resected veins and/or pus expressed at the catheter entrance site. Four patients had candidemia. None were neutropenic or recipients of corticosteroids. All had concomitant or preceding bacterial infections, and had received a median of 5 antibiotics (range 3 to 9) for at least 2 weeks. Five of seven had documented preceding candidal colonization associated with broad spectrum antibiotic therapy. Catheter sites had not been routinely rotated and local catheter site care was deficient. Risk factors of antibiotics and duration of hospitalization were fewer in patients with bacterial suppurative thrombophlebitis. Combined segmental venous resection and intravenous amphotericin B appears to be the most rational therapy for this nosocomial fungal infection.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

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