Duration of antibiotic therapy in central venous catheter-related bloodstream infection due to Gram-negative bacilli

Abstract

Purpose of reviewThe aim of this study was to review recent data evaluating the duration of antibiotic therapy in central venous catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB).Recent findings CRBSI is the most common complication associated with the use of intravascular catheters. CRBSI directly contributes to increase additional days of hospitalization, morbidity and therefore economic costs. The incidence of GNB CRBSI has been increasing considerably in the last years; this has raised a concern due to the high reported rate of multi drug resistant bacteria in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies evaluating the impact of the duration of antibiotic therapy of GNB-CRBSI have shown that short-course antibiotic therapy might be as effective as long-course therapy once the central venous catheter (CVC) has been removed. SummaryCRBSI due to GNB has shown a rapid increase in the last years. Current guidelines recommend antibiotic treatment for at least 7-14 days, although no randomized clinical trials have evaluated the optimal duration of antibiotic therapy for GNB-CRBSI. Recent data suggest that administration of appropriate antibiotic therapy for 7 days or less may be as well tolerated and effective as longer courses in episodes of GNB-CRBSI, once the CVC has been removed.

Ultrasonographic Findings of Catheter‐Related Bloodstream Infection in Pediatric Patients

“…Previous studies have found that older patients have a higher risk for CRBSI than younger patients 40 . This result was consistent with our result.…”

“…Previous studies have found that older patients have a higher risk for CRBSI than younger patients. 40 This result was consistent with our result. Long hospital stays, underlying diseases such as neurological disorders, and solid organ transplantation associated with a higher risk of CRBSI.…”

“…Long hospital stays, underlying diseases such as neurological disorders, and solid organ transplantation associated with a higher risk of CRBSI. 23,40 Chemical or mechanical reaction at the site of the catheter insertion is an important cause of thrombophlebitis. 3,6,41,42 The lumens of central veins are larger than those of peripheral veins; therefore, chemical and mechanical reactions to the catheter have less effect on central veins than that on peripheral veins.…”

How to manage central venous catheter-related bloodstream infections due to Gram-negative bacilli?

“…The main findings of studies analysing the impact of short courses of antibiotic therapy in GNB CRBSI are depicted in Table 3. We could conclude than current available data support that a short course of antibiotic therapy must be as effective as long-course therapy for GNB-CRBSI, once the CVC has been removed [33].…”

Antimicrobial Therapy Duration for Bloodstream Infections Caused by Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex: A Retrospective Cohort Study

“…Enterobacterales species are the predominant etiological agents of Gram-negative BSI, followed by Acinetobacter baumannii-calcoaceticus complex (ABC) and Pseudomonas aeruginosa [ 3 , 4 ] The ideal duration of treatment for Gram-negative bacteria remains undefined, especially in infections caused by multidrug resistant (MDR) pathogens. Guidelines recommend from 7 to 14 days of treatment for Gram-negative BSI, leaving shorter- or longer-term therapies to clinical discretion [ 5 , 6 , 7 ]. Recently, a consensus guidance recommended 7 days of therapy for uncomplicated Gram-negative BSI [ 8 ].…”