Changing Epidemiology of Catheter-Related Bloodstream Infections in Cancer Patients

Chaftari, Anne-Marie; Hachem, Ray; Jiang, Ying; Shah, Pankil; Hussain, Alawami; Hamal, Zainab Al; Yousif, Ammar; Jordan, Mary Ann; Michael, Majd; Raad, Issam

doi:10.1017/ice.2018.75

Cited by 20 publications

(24 citation statements)

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“…This decreasing incidence has also been noted in other studies in general population patients [13][14][15], although to the best of our knowledge, this is one of the firsts studies showing these results in onco-hematological patients. Chaftari et al compared CRBSI in two different periods separated by over a decade [16]. Like our results, these authors showed a significant decrease in the rates of CRBSI between both periods, as well as an increase in the rates of GNB and proportional decrease in GPC.…”

Section: Plos Onesupporting

confidence: 85%

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

et al. 2021

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Background We aimed to describe the epidemiology of catheter-related bloodstream infections (CRBSIs) in onco-hematological neutropenic patients during a 25-year study period, to evaluate the risk factors for Gram-negative bacilli (GNB) CRBSI, as well as rates of inappropriate empirical antibiotic treatments (IEAT) and mortality. Materials/Methods All consecutive episodes of CRBSIs were prospectively collected (1994–2018). Changing epidemiology was evaluated comparing five-year time spans. A multivariate regression model was built to evaluate risk factors for GNB CRBSIs. Results 482 monomicrobial CRBSIs were documented. The proportion of CRBSIs among all BSIs decreased over time from 41.2% to 15.8% (p<0.001). CRBSIs epidemiology has been changing: the rate of GNB increased over time (from 11.9% to 29.4%; p<0.001), as well as the absolute number and rate of multidrug-resistant (MDR) GNB (from 9.5% to 40.0%; p = 0.039). P. aeruginosa increased and comprised up to 40% of all GNB. Independent factors related with GNB-CRBSIs were: longer duration of in-situ catheter (OR 1.007; 95%CI 1.004–1.011), older age (OR 1.016; 95%CI 1.001–1.033), prior antibiotic treatment with penicillins (OR 2.716; 95%CI 1.306–5.403), and current antibiotic treatment with glycopeptides (OR 1.931; 95%CI 1.001–3.306). IEATs were administered to 30.7% of patients, with the highest percentage among MDR P. aeruginosa (76.9%) and S. maltophillia (92.9%). Mortality rate was greater among GNB than GPC-CRBSI (14.4% vs 5.4%; p = 0.002), with mortality increasing over time (from 4.5% to 11.2%; p = 0.003). Conclusion A significant shift towards GNB-CRBSIs was observed. Secondarily, and coinciding with an increasing number of GNB-MDR infections, mortality increased over time.

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Section: Plos Onesupporting

confidence: 85%

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

et al. 2021

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“…E. coli and Klebsiella sp were the most common GN bacteria isolated in both groups. Our data are consistent with those from previous studies that evaluated the most common causative GN organisms in similar populations [1, 9, 13]. These findings are explained by the fact that MBI increases the risk of translocation of the gut microorganisms, such as E. coli and Klebsiella sp, to the systemic circulation.…”

Section: Discussionsupporting

confidence: 92%

“…Over the last 20 years, gram-negative (GN) organisms have become a major cause of bloodstream infections (BSIs), including central line-associated and catheter-related BSIs (CLABSIs and CRBSIs) and non-CLABSIs. This predominance mainly is seen in high-risk patients, such as cancer patients and intensive care unit patients [1–3]. Many studies have evaluated the common GN organisms seen in BSIs and their antimicrobial susceptibility patterns.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have evaluated the common GN organisms seen in BSIs and their antimicrobial susceptibility patterns. Escherichia coli was found to be the predominant pathogen, with a high prevalence of multidrug resistance [1–6]. The Infectious Diseases Society of America (IDSA) recommends central venous catheter (CVC) removal in patients with long-term CVCs and uncomplicated GN CLABSIs; antimicrobial lock therapies are recommended if no other vascular access is available [7].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

Fares

Khalil

Chaftari

et al. 2019

Open Forum Infectious Diseases

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Objective Gram-negative organisms have become a major etiology of bloodstream infections. We evaluated the effect of central venous catheter management on cancer patients with gram-negative bloodstream infections. Method We retrospectively identified patients older than 14 years with central venous catheters who were diagnosed with gram-negative bloodstream infections to determine the effect of catheter management on outcome. Patients were divided into 3 groups: Group 1 included patients with central line-associated bloodstream infections (CLABSI) without mucosal barrier injury and those whose infection met the criteria for catheter-related bloodstream infection; group 2 included patients with CLABSI with mucosal barrier injury who did not meet the criteria for catheter-related bloodstream infection; and group 3 included patients with non-CLABSI. Results The study included 300 patients, with 100 patients in each group. Only in group 1 was central venous catheter removal within 2 days of bloodstream infection significantly associated with a higher rate of microbiologic resolution at 4 days compared to delayed central venous catheter removal (3–5 days) or retention (98% vs 82%, P = .006) and a lower overall mortality rate at 3-month follow-up (3% vs 19%, P = .01). Both associations persisted in multivariate analyses (P = .018 and P = .016, respectively). Conclusions Central venous catheter removal within 2 days of the onset of gram-negative bloodstream infections significantly improved the infectious outcome and overall mortality of adult cancer patients with catheter-related bloodstream infections and CLABSI without mucosal barrier injury.

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“…Os estudos atuais diferem entre si devido à epidemiologia local 46. Chaftari et al, em 2018, revisaram as ICS-CVC em pacientes oncológicos dos anos de 2013 e 2014 e perceberam uma grande mudança epidemiológica e etiológica dos últimos 20 anos em pacientes oncológicos, demonstrando uma equivalência entre ambas, porém predominando os BGN 90. A proporção de Enterobactérias foi significativamente maior entre os pacientes com neoplasias hematológicas.…”

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Impacto da utilização do critério de infecção da corrente sanguínea associada a lesão da barreira mucosa em pacientes com tumores sólidos e neoplasias hematológicas

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Changing Epidemiology of Catheter-Related Bloodstream Infections in Cancer Patients

Cited by 20 publications

References 10 publications

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

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

Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

Impacto da utilização do critério de infecção da corrente sanguínea associada a lesão da barreira mucosa em pacientes com tumores sólidos e neoplasias hematológicas

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