Long-Term Infectious Complications and Their Relation to Treatment Duration in Catheter-Related Staphylococcus aureus Bacteremia

Abstract

The optimal duration of treatment for catheter-related Staphylococcus aureus bacteremia is not known. Short courses (< or = 2 weeks) of therapy should be viewed with caution because essential data on late complications, such as osteomyelitis and metastatic abscesses, are lacking. This study represents a retrospective analysis of the data from 49 adult patients hospitalised in the period 1994-1996 (mean age, 57 years; range, 20-90 years; 47% male) and from whom Staphylococcus aureus was cultured concomitantly from peripheral blood and catheter segments. Forty-six venous catheters, two arterial catheters, and one unknown type of catheter were used. Forty-four patients were treated with effective anti-Staphylococcus aureus antibiotics. Twenty patients had a favourable outcome, defined as no complication and no death during 1 year of follow-up, 24 patients had complications, 14 patients died due to attributable mortality, and 5 other patients died of an underlying disease without showing signs or symptoms of a complication. Patients were categorised according to the duration of treatment. There were small differences between a shorter (1-14 days) and a longer (>14 days) course of antibiotics with regard to favourable outcome (41% vs. 33%), complications (48% vs. 53%), attributable death (31% vs. 20%), and death due to underlying disease (41% vs. 33%), respectively. The rates of complications and death were high, but a definite conclusion cannot be drawn because the study was underpowered. More randomised trials are needed, but, until the results of such trials are available, the duration of therapy should not be shortened to less than 14 days.

Treatment Duration for Uncomplicated Staphylococcus aureus Bacteremia To Prevent Relapse: Analysis of a Prospective Observational Cohort Study

“…There are several observational studies regarding the duration of therapy for S. aureus bacteremia, which usually focused on the management of CRBSI or the recurrence of S. aureus bacteremia (4)(5)(6)(7)(8)(25)(26)(27)(28)(29)(30). In these studies, patients had diverse clinical characteristics of S. aureus bacteremia with various extents and severities of infection.…”

“…However, using this approach for all patients with S. aureus bacteremia is expensive and may result in complications of therapy. Several retrospective studies performed in the 1980s to 1990s suggest 10 to 14 days of short-course therapy for S. aureus bacteremia with eradicable foci, such as an infected catheter, especially if there is no clinical evidence of early metastatic complications (3)(4)(5)(6)(7). However, in these studies, the numbers of patients were small and the proportion of methicillin-resistant S. aureus (MRSA) was not usually reported.…”

Repeating blood cultures during hospital stay: practice pattern at a teaching hospital and a proposal for guidelines

“… New septic episode. A standardised definition of a new septic episode is necessary, perhaps based on a new fever, a change in fever pattern, or new haemodynamic changes consistent with sepsis. Suspected endocarditis when initial cultures were obtained during the period of suppression secondary to recent use of antibiotics. Follow‐up of a positive BC in certain conditions that may have diagnostic and therapeutic implications, such as S. aureus bactaeremia, where the length of therapy may be determined by the duration of bacteraemia [13–15], candidaemia, and bacteraemia caused by Gram‐negative bacilli. Confirmation of response to therapy for endocarditis or other endovascular infections caused by S. aureus , Enterococcus spp., Gram‐negative bacilli or other difficult‐to‐treat organisms. In some of these cases, the use of clinical data may not be reliable because bacteraemia may persist without systemic manifestations during therapy. Confirmation of diagnosis of intravascular catheter‐associated bacteraemia, in some cases by obtaining BCs from the line and a peripheral site before initiating antibiotics. …”

“…3. Follow-up of a positive BC in certain conditions that may have diagnostic and therapeutic implications, such as S. aureus bactaeremia, where the length of therapy may be determined by the duration of bacteraemia [13][14][15], candidaemia, and bacteraemia caused by Gram-negative bacilli. 4.…”

Are Antimicrobial-Impregnated Catheters Effective? Don't Throw Out the Baby with the Bathwater

“…Coagulase-negative staphylococci and enterococci accounted for 160% of the isolates in 2 of these 3 studies [39,40], diluting the far greater attributable mortality of CVC-related BSIs caused by more pathogenic organisms, such as Staphylococcus aureus [41][42][43][44][45][46][47][48] and Candida species [49][50][51][52][53][54]. Furthermore, we believe that, although all 3 of these case-control studies were laudable in their attempts to adjust for the presence of confounding variables in their patient populations, 2 had problems matching case patients to control subjects, as witnessed by the divergence of severity-of-illness scores among study participants after matching but well before onset of CVC-related BSI [38] and a paradoxically increased mortality among control patients [40].…”