Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort

Abstract

Background Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances. Objectives To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI. Methods Patients with CRBSI were selected from the PROBAC cohort, a prospective, observational, multicentre national cohort study including patients with bloodstream infections consecutively admitted to 26 Spanish hospitals in a 6 month period (October 2016–March 2017). Outcome variables were GNB aetiology and 30 day mortality. Adjusted analyses were performed by logistic regression. Results Six hundred and thirty-one episodes of CRBSI were included in the study. Risk factors independently related to GNB aetiology were central venous catheter (CVC) [OR 1.60 (95% CI: 1.05–2.44), P = 0.028], sepsis/septic shock [OR: 1.76 (95% CI: 1.11–2.80), P = 0.016], antibiotic therapy in the previous 30 days [OR: 1.56 (95% CI: 1.02–2.36), P = 0.037], neutropenia <500/μL [OR: 2.01 (95% CI: 1.04–3.87), P = 0.037] and peripheral vascular disease [OR: 2.04 (95% CI: 1.13–3.68), P = 0.018]. GNB were not associated with increased mortality in adjusted analysis, while removal of catheter [OR: 0.24 (95% CI: 0.09–0.61), P = 0.002] and adequate empirical treatment [OR: 0.37 (95% CI: 0.18–0.77), P = 0.008] were strong protective factors. Conclusions Our study reinforces the recommendation that empirical coverage should cover GNB in patients presenting with sepsis/septic shock and in neutropenic patients. Catheter removal and adequate empirical treatment were both protective factors against mortality in patients with CRBSI.

Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients

“…In the last years, a shift towards a progressive increase in GNB in the overall BSI episodes in oncohematological patients has been described [12,[19][20][21], with some studies reporting even a predominance of GNB [22][23][24]. Additionally, some studies have identified neutropenia to be an independent risk factor for presenting a CRBSI caused by GNB [25]. The specifical changes reported in this study, with a progressive linear increase in the percentage of GNB among CRBSIs in neutropenic patients, as well as in other CRBSI studies in the general population [13,26,27], might be at least partially explained by the increasing age and complexity of patients.…”

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

“…In the training cohort, 575 (15%, 95% confidence interval (CI) [ 14 – 16 ]) catheters were colonized. Among 597 catheters removed for suspected CRI, 477 (80%, 95% CI [77–83]) were culture-negative.…”

“…Similar results were observed in a prospective observational study by Lorente et al [ 13 ]. On the other hand, the absence of focus eradication (i.e., CVC removal) is clearly associated with mortality in the setting of CRBSI [ 14 – 16 ]. Consequently, the decision to remove the CVC is generally left at the physician’s judgement and experience.…”

Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project

“…This is a post hoc analysis of the PROBAC project, a prospective, observational, multicenter cohort study, including consecutive patients with bloodstream infections (BSI) admitted to 26 Spanish hospitals from October 2016 to March 2017; the design and inclusion criteria have been described elsewhere ( 8 , 17 ).…”