Impact of Central Venous Catheter Removal on the Recurrence of Catheter-Related Coagulase-Negative Staphylococcal Bacteremia

Abstract

OBJECTIVE: To determine the impact of catheter management on the acute and long-term outcome of catheter-related coagulase-negative staphylococcal bacteremia. DESIGN: Retrospective surveillance of catheter-related sepsis using quantitative blood and catheter cultures. SETTING: University-affiliated tertiary cancer center. PATIENTS AND METHODS: seventy patients with catheter-related coagulase-negative staphylococcal bacteremia were studied by retrospective chart review. The clinical characteristics of the patients and the management of the bacteremias were determined. The impact of immunosuppressive risk factors, antibiotic therapy, and catheter management on the recurrence of the bacteremia was investigated. RESULTS: Acute sepsis-related morbidity and mortality were not related to catheter manage-From the

Catheter-related bloodstream infection with removal of catheter in pediatric oncology patients: a 10-year experience in Taiwan

“…Current guidelines by the Infectious Diseases Society of America on the management of intravascular catheters in patients with CRBSI do not recommend routine removal of the CVC [2]. Several studies have demonstrated that CVC retention in CONS CRBSI does not affect the associated acute mortality; however, CVC retention was significantly associated with a higher rate of recurrence of bacteremia [9,18,19]. However, in complicated infections, i.e.…”

Diagnosis of catheter-related bloodstream infection

“…The absence of such deep-seated infections characterizes uncomplicated bacteremia. A positive blood culture while the patient is on therapy or the presence of imaging proof may be indicative of complications; a venogram may be useful to detect septic phlebitis, whereas a fundoscopic exam is helpful in examining the possibility of retinitis, especially in patients with persistent bacteremia or candidemia caused by Staphylococcus aureus or Candida [43][44][45][46][47]. In addition, Fowler et al [46] determined that transesophageal echocardiography is highly effective and essential to establish the diagnosis of endocarditis in patients with S. aureus bacteremia.…”

“…In some cases of uncomplicated infection caused by coagulase-negative staphylococci, the catheter may be retained, though retention has been shown to increase the risk of recurrence of bacteremia [47]. Patients with complicated infections should undergo catheter removal and subsequent appropriate antibiotic treatment for 4 to 6 weeks, if the complications are septic thrombosis or endocarditis, or 6 to 8 weeks, if complicated with osteomyletis [48].…”

Diagnosis of central venous catheter related infection in adult patients

“…28 Previous work has shown that at least 80% of catheter related bacteraemia due to CNS may be successfully treated with antibiotics without removal of the catheter, thus emphasizing the need for an accurate diagnosis. 29 To further complicate the clinical diagnosis of CRI there is often a poor correlation between the clinical assessment and laboratory findings. 30 As the CNS are the predominant causative micro-organism associated with CRI, the interpretation of microbiological findings is often complex as positive blood or catheter segment cultures may represent catheter colonization, infection, or sample contamination.…”