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Central Venous Catheter–Related Bacteremia Due to Gram-Negative Bacilli: Significance of Catheter Removal in Preventing Relapse

Published online by Cambridge University Press:  02 January 2015

Hend Hanna ,
Claude Afif ,
Badie Alakech ,
Maha Boktour ,
Jeffrey Tarrand ,
Ray Hachem  and
Issam Raad
Hend Hanna*
Affiliation:
Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Claude Afif
Affiliation:
University of Balamand, Beirut, Lebanon
Badie Alakech
Affiliation:
Texas Tech University Health Science Center, Lubbock, Texas
Maha Boktour
Affiliation:
Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Jeffrey Tarrand
Affiliation:
Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Ray Hachem
Affiliation:
Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Issam Raad
Affiliation:
Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
*
The University of Texas M. D. Anderson Cancer Center, Department of Infectious Diseases, Infection Control and Employee Health (Unit 402), 1515 Holcombe Blvd., Houston, TX 77030
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Abstract

Objective:

To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal.

Design:

This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records.

Setting:

University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.

Patients:

Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills).

Results:

Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02–0.75; P = .02).

Conclusion:

In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 8 , August 2004 , pp. 646 - 649
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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