Catheter-Related Staphylococcus aureus Bacteremia and Septic Thrombosis: The Role of Anticoagulation Therapy and Duration of Intravenous Antibiotic Therapy

Abstract

BackgroundCatheter-related septic thrombosis is suspected in patients with persistent central line–associated bloodstream infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. The clinical diagnosis and management of this entity can be challenging as limited data are available. We retrospectively studied the clinical characteristics of patients with Staphylococcus aureus catheter-related septic thrombosis and the outcomes related to different management strategies.MethodsThis retrospective study included patients with CLABSI due to S. aureus who had concomitant radiographic evidence of catheter site thrombosis treated at our institution between the years 2005 and 2016. We collected data pertaining to patients’ medical history, clinical presentation, management, and outcome within 3 months of bacteremia onset.ResultsA total of 128 patients were included. We found no significant difference in overall outcome between patients who had deep vs superficial thrombosis. Patients with superficial thrombosis were found to have a higher rate of pulmonary complications (25% vs 6%; P = .01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs 5%; P = .001). A multivariate logistic regression analysis identified 2 predictors of treatment failure: ICU admission during their illness (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.08–6.99; P = .034) and not receiving anticoagulation therapy (OR, 0.24; 95% CI, 0.11–0.54; P < .001).ConclusionsOur findings suggest that the presence of S. aureus CLABSI in the setting of catheter-related thrombosis may warrant prolonged intravascular antimicrobial therapy and administration of anticoagulation therapy in critically ill cancer patients.

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

“…The duration of treatment of suppurative thrombophlebitis is based on expert opinions. A recent retrospective study on patients with S. aureus suppurative thrombophlebitis showed that a duration of antibiotic therapy shorter than 28 days and the absence of anticoagulant therapy were associated with higher rates of treatment failure [ 172 ].…”

Uncomplicated Staphylococcus aureus Bacteremia Treatment Duration and Outcomes at an Academic Medical Center

“…However, in patients without persistent bacteremia, determination of whether a thrombus is actively infected is difficult, and guidance is lacking. Regardless of duration of bacteremia, thrombosis in this setting has been associated with poor outcomes if treated with <28 days of antibiotic therapy [ 10 ]. The presence of thrombosis should therefore be considered when determining the treatment duration in SAB.…”

Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside

“…Septic thrombosis (ST) is a serious and potentially fatal condition defined by the presence of an endovascular thrombus in the setting of associated bacterial or fungal infection [1][2][3][4]. The cornerstones of ST treatment include prolonged and targeted antimicrobial therapy and anticoagulation [1,4,5]. Furthermore, in selected cases surgical debridement may also be required [6][7][8].…”