Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis

Abstract

Background Catheter-related bloodstream infection (CRBSI) is a life-threatening complication of parenteral nutrition. Therefore, optimal management, ideally with catheter salvage, is required to maintain long-term venous access. Objectives We aimed to evaluate successful catheter salvage rates in patients on home parenteral nutrition (HPN). Methods Studies were retrieved from medical databases, conference proceedings, and article reference lists. Data were collected relating to clinical outcomes of 3 treatments: systemic antibiotics, antimicrobial lock therapy (ALT), and catheter exchange. ORs and 95% CIs were calculated from a mixed logistic effects model. Results From 10,036 identified publications, 28 met the inclusion criteria (22 cohort studies, 5 case-control studies, and 1 randomized clinical trial), resulting in a total of 4911 CRBSIs. To achieve successful catheter salvage, the addition of an antimicrobial lock solution was superior to systemic antibiotics alone (OR: 1.75; 95% CI: 1.21, 2.53; P = 0.003). Recurrence of infection was less common in studies that used ALT than in those that used systemic antibiotics alone (OR: 0.26; 95% CI: 0.11, 0.61; P = 0.002). The catheter exchange group was excluded from multilevel regression analysis because only 1 included study applied this treatment. Successful salvage rates were highest for coagulase-negative staphylococci, followed by Gram-negative rods and Staphylococcus aureus . Conclusions The addition of an antimicrobial lock solution seems beneficial for successful catheter salvage in HPN-dependent patients with a CRBSI. Future prospective randomized studies should identify the most effective and pathogen-specific strategy. This review was registered at www.crd.york.ac.uk/PROSPERO as CRD42018102959.

Catheter salvage or removal in catheter‐related bloodstream infections with Staphylococcus aureus in children with chronic intestinal failure receiving home parenteral nutrition and the use of prophylactic taurolidine catheter lock solution: A descriptive cohort study

“…The successful catheter salvage rate of 100% in our cohort is high compared with that of previous literature. A systematic review reported a successful catheter salvage rate of 54% of a total of 340 S aureus CRBSIs in adult patients with IF receiving HPN (54%; range, 25%–100%) 29 . Two other studies in adult patients with cancer with indwelling catheters who were diagnosed with S aureus CRBSIs reported a catheter salvage rate between 75% and 85%, with a success rate between 50% and 60% 30,31 .…”

“…CRBSIs in adult patients with IF receiving HPN (54%; range, 25%-100%). 29 Two other studies in adult patients with cancer with indwelling catheters who were diagnosed with S aureus CRBSIs reported a catheter salvage rate between 75% and 85%, with a success rate between 50% and 60%. 30,31 However, a wide variety of definitions of successful catheter salvage between these studies existed, varying from solely negative blood cultures after completing antimicrobial therapy to no recurrence of infection within 3 months.…”

Short bowel syndrome: Complications and management

“…As a consequence, CVC salvage therapy should be attempted depending on the severity of the clinical presentation and the culprit organism and therapeutic susceptibilities 75 . Salvage success rates are higher when treating infections due to coagulase‐negative staphylococci and are lowest for infections from Staphylococcus aureus and polymicrobial infections 76 . Salvage should not be attempted in the setting of fungal infections, most gram‐negative infections, or critically ill patients 73 .…”

“…75 Salvage success rates are higher when treating infections due to coagulase-negative staphylococci and are lowest for infections from Staphylococcus aureus and polymicrobial infections. 76 Salvage should not be attempted in the setting of fungal infections, most gram-negative infections, or critically ill patients. 73 If line salvage is pursued, infusion of targeted systemic antibiotics should occur through the contaminated line as part of the salvage strategy.…”

Home Parenteral and Enteral Nutrition

“…Catheter salvage success is primarily dependent on the culprit organism and therapeutic susceptibilities [43]. In a recent review and metaanalysis evaluating CVC salvage in adult patients on HPN, it was found that successful catheter salvage rates were highest in patients with coagulase-negative staphylococci followed by Gram-negative bacteria, while the lowest rates of successful catheter salvage were seen in patients with S. aureus and polymicrobial infections [46]. One technique for CVC salvage, as well as CRBSI prevention, has been the use of antibiotic lock therapy [43,47,48].…”