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

Abstract

Background A progressive increase in the incidence of catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB) has been reported. Current guidelines recommend antibiotic treatment for at least 7–14 days, although the supporting evidence is limited. Methods We performed a retrospective single-centre study including all patients with a definite diagnosis of GNB CRBSI from January 2012 to October 2018 in which the central venous catheter (CVC) was removed. The occurrence of therapeutic failure [clinical failure (persistence of symptoms and laboratory signs of infection), microbiological failure (persistent bacteraemia or relapse) and/or all-cause 30 day mortality] was compared between episodes receiving short [≤7 days (SC)] or long courses [>7 days (LC)] of appropriate antibiotic therapy following CVC removal. Results We included 54 GNB CRBSI episodes with an overall rate of therapeutic failure of 27.8% (15/54). Episodes receiving SC therapy were more frequently due to MDR GNB [60.9% (14/23) versus 34.5% (10/29); P = 0.058] and had higher Pitt scores [median (IQR) 1 (0–4) versus 0 (0–2); P = 0.086]. There were no significant differences in the rate of therapeutic failure between episodes treated with SC or LC therapy [30.4% (7/23) versus 27.6% (8/29); OR 1.15; 95% CI 0.34–3.83; P = 0.822]. The use of SCs was not associated with increased odds of therapeutic failure in any of the exploratory models performed. Conclusions The administration of appropriate antibiotic therapy for ≤7 days may be as safe and effective as longer courses in episodes of GNB CRBSI once the CVC has been removed.

Short-Course Versus Long-Course Systemic Antibiotic Treatment for Uncomplicated Intravascular Catheter-Related Bloodstream Infections due to Gram-Negative Bacteria, Enterococci or Coagulase-Negative Staphylococci: A Systematic Review

“…All cohort studies assessed the whole database of their institutions to identify patients fulfilling the inclusion criteria. Adult patients were included in four studies [ 24 , 26 , 27 , 29 ], whereas four studies included patients of all ages [ 22 , 23 , 25 , 28 ]. Catheter removal was mandatory for inclusion in five studies [ 22 – 24 , 27 , 29 ].…”

“…Adult patients were included in four studies [ 24 , 26 , 27 , 29 ], whereas four studies included patients of all ages [ 22 , 23 , 25 , 28 ]. Catheter removal was mandatory for inclusion in five studies [ 22 – 24 , 27 , 29 ]. No study assessed antibiotic-associated adverse events.…”

“…of patients/total no. of patients Additional comment All-cause mortality Clinical cure Relapse Short-course Long-course Short-course Long-course Short-course Long-course Gram-negative bacteria Ruiz-Ruigòmez et al 2020 [ 22 ] 30-day mortality 3/23 (13%) 30-day mortality 1/29 (3%) 18/23 (78%) 23/29 (79%) 1/23 (4%) 0/29 (0%) Assessment of outcomes for 52 of 54 included patients Lee et al 2021 [ 24 ] 30-day mortality 4/30 (13%) 30-day mortality 6/29 (21%) 22/30 (73%) 18/29 (62%) 1/30 (3%) 1/29 (3%) Surapat et al . 2020 [ 29 ] 1/11 (9%) 4/33 (12%) Not performed Not performed 0/11 (0%) 1/33 (3%) We described only the phase 2 of the study Coagulase-negative staphylococci Hebeisen et al .…”

“…The risk of bias was assessed by the Newcastle–Ottawa scale [ 21 ] (Table 2 ). According to our study assessment seven studies [ 23 – 29 ] were of low methodological quality while one study [ 22 ] was of moderate quality.…”

“…The main characteristics of the included studies are presented in Table 1. Among eight included studies, seven were cohort studies [22][23][24][25][26][27][28]. One study described a retrospective cohort (i.e.…”