scholarly journals Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Johny Fares ◽  
Melissa Khalil ◽  
Anne-Marie Chaftari ◽  
Ray Hachem ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Mucosal Barrier ◽  
Central Venous ◽  
Gram Negative ◽  
Central Venous Catheter Removal ◽  
Mucosal Barrier Injury

Abstract Objective Gram-negative organisms have become a major etiology of bloodstream infections. We evaluated the effect of central venous catheter management on cancer patients with gram-negative bloodstream infections. Method We retrospectively identified patients older than 14 years with central venous catheters who were diagnosed with gram-negative bloodstream infections to determine the effect of catheter management on outcome. Patients were divided into 3 groups: Group 1 included patients with central line-associated bloodstream infections (CLABSI) without mucosal barrier injury and those whose infection met the criteria for catheter-related bloodstream infection; group 2 included patients with CLABSI with mucosal barrier injury who did not meet the criteria for catheter-related bloodstream infection; and group 3 included patients with non-CLABSI. Results The study included 300 patients, with 100 patients in each group. Only in group 1 was central venous catheter removal within 2 days of bloodstream infection significantly associated with a higher rate of microbiologic resolution at 4 days compared to delayed central venous catheter removal (3–5 days) or retention (98% vs 82%, P = .006) and a lower overall mortality rate at 3-month follow-up (3% vs 19%, P = .01). Both associations persisted in multivariate analyses (P = .018 and P = .016, respectively). Conclusions Central venous catheter removal within 2 days of the onset of gram-negative bloodstream infections significantly improved the infectious outcome and overall mortality of adult cancer patients with catheter-related bloodstream infections and CLABSI without mucosal barrier injury.

scholarly journals 120. The Impact of Early Central Venous Catheter Removal in the Management of Enterococcus Central Line-Associated Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S90-S91
Author(s):  
Hesham Awadh ◽  
Melissa Khalil ◽  
Anne-Marie Chaftari ◽  
Johny Fares ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Mucosal Barrier ◽  
Causative Organism ◽  
Central Venous ◽  
Central Venous Catheter Removal ◽  
The Impact

Abstract Background There has been a rise in Enterococcus species Central Line-Associated Bloodstream Infections (CLABSI) ranking as the third overall causative organism according to the Center for Disease Control and Prevention (CDC) report issued in 2014. Central Venous Catheter (CVC) management including the need and timing of CVC removal is not well defined for enterococcus bacteremia (EB) in the 2009 Infectious Diseases Society of America (IDSA) management guidelines given the paucity of studies addressing CVC management. Methods We conducted a retrospective chart review on 543 patients diagnosed with EB between 2010 and 2018. We excluded patients without an indwelling CVC and those with mucosal barrier injury (MBI). We further evaluated 90 patients with EB that met the CDC definition for CLABSI without MBI or the IDSA definition for catheter-related bloodstream infections (CRBSI) and 90 patients with an indwelling CVC in place with documented non-CLABSI with another source. Results Early CVC removal (within 3 days of EB) was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (43% vs. 27%; P = 0.02). Microbiological eradication associated with early CVC removal within 3 days of EB was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (78% vs. 48%; P = 0.016). Complications were lower in the CLABSI without MBI/CRBSI compared with the non-CLABSI group (0% vs. 18%; P = 0.017). Defervescence, mortality (all-cause and infection-related mortality) and relapse were similar in both groups. Within each group, the outcome was similar irrespective of CVC management (removal within 3 days vs. retention). Conclusion In cases of EB, early CVC removal within 3 days of bacteremia is associated with a favorable outcome in the CLABSI without MBI/CRBSI group compared with the non-CLABSI group. Disclosures All authors: No reported disclosures.

Prominent Prevalence of Coagulase-Negative Staphylococcus Bloodstream Infections in Neutropenic Hematology/Oncology Children with Central Venous Catheter

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4664-4664
Author(s):  
Young-Ho Lee ◽  
Yeon Jung Lim ◽  
Soon-young Song ◽  
Ji-hye Kim ◽  
Sung-hee Oh ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Retrospective Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative Bacteria ◽  
Central Venous ◽  
Gram Negative ◽  
Susceptibility Tests ◽  
Febrile Episodes

Abstract A retrospective analysis was performed on febrile neutropenic episodes in children with hematologic and oncologic diseases from 2005 to 2008. We reviewed total 255 febrile episodes occurred during the 3-year period in a total of 114 patients. Twenty-eight episodes of bacteremia occurred during neutropenic period in a total of 16 patients. All these patients had central venous catheter. There were 18 febrile episodes of Grampositive bacteria (64.3%), 9 episodes of Gram-negative bacteria (32.1%), and 1 episode of Candida (3.6%). The isolated organisms were as follows: Coagulase-negative Staphylococcus (CNS, N=17, 60.7%), Staphylococcus aureus (N=1, 3.6%), Enterobacter spp. (N=2, 7.1%), Pseudomonas spp. (N=2, 7.1%), Klebsiella (N=2, 7.1%), E. coli (N=2, 7.1%), Acinetobacter (N=1, 3.6%), Candida. (N=1, 3.6%). The bloodstream infection with CNS were more prevalent in children with Chemo-port (12 episodes in 6 from 34 patients, 17.6%) than in children with Hickman catheter (5 episodes in 5 from 22 patents, 22.7%), even though statistically not significant. In antibiotic susceptibility tests, all gram positive bacteria were resistant to penicillin and oxacillin, and sensitive to vancomycin and teicoplanin. In the case of Gram-negative bacteria, resistant rates to amikacin, gentamicin, imipenem, and piperacillin/tazobactam were 4.8%, 38.1%, 14.3%, and 42.9%, respectively. Based on this retrospective analysis, which reflects predominance of CNS bacteremia in febrile neutropenic patients, more emphasis needs to be laid on the empirical antibiotic regimen including vancomycin or teicoplanin as well as the strict skin preparations during procedures in children with central venous catheter.

scholarly journals Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens

2011 ◽  
Vol 66 (9) ◽  
pp. 2119-2125 ◽  
Author(s):  
M. Marcos ◽  
A. Soriano ◽  
A. Inurrieta ◽  
J. A. Martinez ◽  
A. Romero ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous ◽  
Gram Negative

Impact of duration of antibiotic therapy in central venous catheter-related bloodstream infection due to Gram-negative bacilli

2020 ◽  
Vol 75 (10) ◽  
pp. 3049-3055
Author(s):  
María Ruiz-Ruigómez ◽  
Mario Fernández-Ruiz ◽  
Rafael San-Juan ◽  
Francisco López-Medrano ◽  
María Ángeles Orellana ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Antibiotic Therapy ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Progressive Increase ◽  
Therapeutic Failure ◽  
Supporting Evidence ◽  
Central Venous ◽  
Gram Negative ◽  
Catheter Related Bloodstream Infection

Abstract Background A progressive increase in the incidence of catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB) has been reported. Current guidelines recommend antibiotic treatment for at least 7–14 days, although the supporting evidence is limited. Methods We performed a retrospective single-centre study including all patients with a definite diagnosis of GNB CRBSI from January 2012 to October 2018 in which the central venous catheter (CVC) was removed. The occurrence of therapeutic failure [clinical failure (persistence of symptoms and laboratory signs of infection), microbiological failure (persistent bacteraemia or relapse) and/or all-cause 30 day mortality] was compared between episodes receiving short [≤7 days (SC)] or long courses [>7 days (LC)] of appropriate antibiotic therapy following CVC removal. Results We included 54 GNB CRBSI episodes with an overall rate of therapeutic failure of 27.8% (15/54). Episodes receiving SC therapy were more frequently due to MDR GNB [60.9% (14/23) versus 34.5% (10/29); P = 0.058] and had higher Pitt scores [median (IQR) 1 (0–4) versus 0 (0–2); P = 0.086]. There were no significant differences in the rate of therapeutic failure between episodes treated with SC or LC therapy [30.4% (7/23) versus 27.6% (8/29); OR 1.15; 95% CI 0.34–3.83; P = 0.822]. The use of SCs was not associated with increased odds of therapeutic failure in any of the exploratory models performed. Conclusions The administration of appropriate antibiotic therapy for ≤7 days may be as safe and effective as longer courses in episodes of GNB CRBSI once the CVC has been removed.

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