Candidal suppurative peripheral thrombophlebitis: Recognition, prevention, and management

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 chrombophlebitis 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.