Microbial epidemiology and risk factors for relapse in gram-negative bacteria catheter-related bloodstream infection with a pilot prospective study in patients with catheter removal receiving short-duration of antibiotic therapy

Abstract

Background: Infectious Diseases Society of America (IDSA) guidelines suggest 7-14 days' duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). The objectives of this study were to review microbial epidemiology, to determine rate and risk factors for relapse, and to compare clinical outcomes in patients receiving long-versus short-duration antibiotic therapy. Methods: A retrospective phase 1 study was conducted between January 2010 and October 2016 to review microbial epidemiology and to determine the incidence of and risk factors for relapse in patients with GNB CRBSI, according to the IDSA guidelines diagnostic criteria. In phase 2 of the study, patients without risk factors for relapse between November 2016 and October 2017 were prospectively recruited to receive antibiotic therapy for 7 days after catheter removal. Matched patients from the retrospective phase 1 study who had received antibiotic therapy for ≥14 days were selected as a phase 2 control group to compare outcomes. Results: In phase 1, three most common pathogens identified among 174 cases were Pseudomonas aeruginosa (22.0%), Klebsiella pneumoniae (16.7%), and Stenotrophomonas maltophilia (13.4%). Eighty-nine episodes of infection occurred while patients were receiving antibiotic therapy. Of 140 cases, the relapse rate was 6.4%. Catheter retention was the only risk factor strongly associated with relapse (odds ratio = 145.32; 95% confidence interval 12.66-1667.37, P < 0.001). In phase 2, 11 patients with catheter removal were prospectively recruited to receive short-duration therapy. The number of patients with relapse receiving long-or short-duration therapy was 1 (3%) and 0 (0%), respectively (P = 1.000).

Non-PSEUDO-AntiBiotiCs Score—A Predictor of Bacteraemia Caused by Pseudomonas aeruginosa: A Case-control Study

“…In comparison to ndings in previous studies, one of the new independent associated factors identi ed in this study was CLABSI/PLABSI. This result could be explained by the fact that P. aeruginosa is the most common gram-negative rod causing CLABSI/PLABSI, while E. coli is relatively rare [23,24]. A previous study showed the above trend, but the nding was not statistically signi cant [11].…”

Short-Course Versus Long-Course Systemic Antibiotic Treatment for Uncomplicated Intravascular Catheter-Related Bloodstream Infections due to Gram-Negative Bacteria, Enterococci or Coagulase-Negative Staphylococci: A Systematic Review

“…“phase 2”). The cases in the phase 2 were matched with controls of phase 1 and we only included the results of the case-cohort phase [ 29 ]. The total number of included patients was 780 with numbers ranging from 44 to 188 patients per study.…”

“…All cohort studies assessed the whole database of their institutions to identify patients fulfilling the inclusion criteria. Adult patients were included in four studies [ 24 , 26 , 27 , 29 ], whereas four studies included patients of all ages [ 22 , 23 , 25 , 28 ]. Catheter removal was mandatory for inclusion in five studies [ 22 – 24 , 27 , 29 ].…”

“…Adult patients were included in four studies [ 24 , 26 , 27 , 29 ], whereas four studies included patients of all ages [ 22 , 23 , 25 , 28 ]. Catheter removal was mandatory for inclusion in five studies [ 22 – 24 , 27 , 29 ]. No study assessed antibiotic-associated adverse events.…”

“…of patients included Setting Patients characteristics Catheter removal Interventions Age (years), mean (± SD) Sex (male gender in %) Antibiotic course by duration Short-course Long-course Gram-negative bacteria Ruiz-Ruigòmez et al 2020 [ 22 ] Retrospective cohort study; 2012–2018; Spain 54 patients Tertiary-care hospital 57.9 (± 15.9) 59.3% Catheter removal mandatory for inclusion ≤ 7 days > 7 days Lee et al 2021 [ 24 ] Retrospective cohort study; 2007–2016; South Korea 59 patients Two tertiary-care hospitals 69 (59–73) a 52.5% Catheter removal mandatory for inclusion ≤ 7 days > 7 days Surapat et al . 2020 [ 29 ] Case-cohort study 2016–2017; Thailand 44 patients Tertiary-care hospital 67 (18–81) b 47.8% Catheter removal mandatory for inclusion 7 days ≥ 14 days Coagulase-negative staphylococci Hebeisen et al . 2019 [ 27 ] Retrospective cohort study; 2008–2016; Switzerland 184 patients Tertiary-care hospital 61 (51–67) a …”