Management of the catheter in documented catheter-related coagulase-negative staphylococcal bacteremia: remove or retain?

Clin Infect Dis. 2009 Oct 15;49(8):1187-94. doi: 10.1086/605694.

Abstract

Background: Studies and guidelines recommending the retention of the central venous catheter (CVC) in patients with coagulase-negative staphylococcal bacteremia were based on loose definitions of bacteremia and/or did not evaluate the risk of recurrence. In this study, we used strict definitions of coagulase-negative staphylococcal bacteremia to determine the impact of CVC retention on response to and recurrence of infection.

Methods: During the period from July 2005 through December 2007, we retrospectively evaluated 188 patients with coagulase-negative staphylococcal bacteremia. Bacteremia was defined using the strict Centers for Disease Control and Prevention criteria of 2 positive blood culture results. Catheter-related bacteremia was confirmed by differential quantitative blood cultures (>or=3:1) or time to positivity (>2 h).

Results: Resolution of infection within 48 h after commencement of antimicrobial therapy was not influenced by CVC removal or exchange versus retention and occurred in 175 patients (93%). Multiple logistic regression analysis showed that infection was 7.0 times (95% confidence interval [CI], 1.5-32.6 times) more likely to fail to resolve in patients with an intensive care unit stay prior to infection ( P = .013 ) and 3.8 times (95% CI, 1.1-13.3 times) more likely to fail to resolve in patients who had other concurrent sites of infection (P = .041 ). Duration of therapy did not affect recurrence. Multiple logistic regression analysis revealed that patients with catheter retention were 6.6 times (95% CI, 1.8-23.9 times) more likely to have a recurrence than were those whose catheter was removed or exchanged (P = .004).

Conclusions: CVC retention does not have an impact on the resolution of coagulase-negative staphylococcal bacteremia but is a significant risk factor of recurrence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / microbiology*
  • Bacteremia / therapy*
  • Catheter-Related Infections / microbiology*
  • Catheter-Related Infections / therapy*
  • Catheterization, Central Venous / adverse effects
  • Child
  • Child, Preschool
  • Coagulase / biosynthesis
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Staphylococcal Infections / microbiology*
  • Staphylococcal Infections / therapy*
  • Staphylococcus / enzymology
  • Staphylococcus / isolation & purification*
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Coagulase