Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections

Braun, Eyal; Hussein, Khetam; Geffen, Yuval; Rabino, Galit; Bar-Lavie, Yaron

doi:10.1111/1469-0691.12565

Cited by 46 publications

(37 citation statements)

References 11 publications

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“…In critically ill patients, the attributable mortality of CRB and fungaemia in the USA ranges from 2% to 35% [21,22], rates in accordance with our results. Braun et al [23] described an increase in CRB-associated mortality concomitantly with a shift towards Gram-negative bacteria in their institution; however, we have not observed this shift in our hospital. To our knowledge, there are no recent data on CRB-associated mortality focusing in non-critically ill patients and no data on PN-CRB-associated mortality.…”

Section: Discussioncontrasting

confidence: 82%

“…Braun et al . described an increase in CRB‐associated mortality concomitantly with a shift towards Gram‐negative bacteria in their institution; however, we have not observed this shift in our hospital. To our knowledge, there are no recent data on CRB‐associated mortality focusing in non‐critically ill patients and no data on PN‐CRB‐associated mortality.…”

Section: Discussioncontrasting

confidence: 73%

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Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia

Rodríguez-Pardo

Almirante

Fernández-Hidalgo

et al. 2014

Clinical Microbiology and Infection

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Catheter-related bacteraemia (CRB) is a cause of death in hospitalized patients, and parenteral nutrition (PN) is a risk factor. We aim to describe the prognosis of PN-CRB and the impact of catheter extraction within 48 h from bacteraemia. All consecutive hospitalized adult patients with CRB (2007-2012) were prospectively enrolled. Factors associated with 30-day mortality were determined by logistic regression analysis. Among 847 episodes of CRB identified, 291 (34%) episodes were associated with short-term catheter use for PN. Cure was achieved in 236 (81%) episodes, 42 (14.5%) patients died within the first 30 days, 7 (2.5%) relapsed, and 6 (2%) had re-infection. On multivariate analysis, previous immunosuppressive therapy (OR 5.62; 95% CI 1.69-18.68; p 0.0048) and patient age (OR 1.05; 95% CI 1.02-1.07; p 0.0009) were predictors of 30-day mortality, whereas catheter removal within 48 h of bacteraemia onset (OR 0.26; 95% CI 0.12-0.58; p 0.0010) and adequate empirical antibiotic treatment (OR 0.36; 95% CI 0.17-0.77; p 0.0081) were protective factors. Incidence of PN-CRB decreased from 5.36 episodes/1000 days of PN in 2007 to 2.9 in 2012, yielding a 46.1% rate reduction (95% CI 15.7-65.5%), which may be attributable to implementation of a multifaceted prevention strategy. In conclusion, short-term PN-CRB accounted for one-third of all episodes of CRB in our setting, and 14.5% of patients died within 30 days following bacteraemia. Our findings suggest that prompt catheter removal and adequate empirical antibiotic treatment could be protective factors for 30-day mortality. Concomitantly with implementation of a multifaceted prevention strategy, PN-CRB incidence was reduced by half.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussioncontrasting

confidence: 73%

Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia

Rodríguez-Pardo

Almirante

Fernández-Hidalgo

et al. 2014

Clinical Microbiology and Infection

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“…10,11 Moreover recent studies have also shown the leading cause of CRBSI to be gram negative bacilli. 12 Acenitobacter baumannii was the most common organism isolated (29%) which is in contrast with the similar studies done in the past, [6][7][8][9][10][11] where some of the studies showed Staph. aureus, CONS and Pseudomonas aeruginosa as the commonest organism colonizing CVC.…”

Section: Escherichia Coli 1(5)mentioning

confidence: 68%

Bacteriological profile and their antimicrobial susceptibility pattern in central venous catheter tip culture

et al. 2017

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Background: Bacterial colonization of central venous catheter carries risk of developing catheter-related blood stream infections. The purpose of this study is to find out the frequency of colonization of by different bacterial pathogens and their antibiotic sensitivity pattern.. Materials and Methods:A total of 53 tip were received in one-year duration for culture and antibiotic sensitivity pattern. The isolated organisms were identified by standard microbiological procedure and subjected to antimicrobial sensitivity. Results:Out of 53 tip sent for culture and sensitivity, 21 (39.6%) showed significant growth. Out of 21 culture positive 52.3% were gram negative bacilli, 33.3% were gram positive cocci, 4.8% were Candida spp. Acenitobacter baumannii and Staphylococcus aureus were frequent pathogens isolated. Gram negative bacteria were less sensitive to antibiotics whereas gram positive bacteria were sensitive to Vancomycin. Conclusion: Though various organisms were isolated as colonizer of CVC, Acenitobacter baumannii is the most common colonizer. Antibiotic resistance has already emerged and represents a major problem.

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“…Historically, the etiology of catheter‐related infections has predominantly been gram positive bacteria, especially CONS. However, there has been an increase in the proportion of gram negative bacteria associated CRBSI over time . A study involving patients with hematologic malignancies from the Royal Melbourne Hospital in Australia did show GNBs as the cause of CRBSI in 68% patients .…”

Section: Discussionmentioning

confidence: 99%

“…The decision to remove a CVC is dictated not only by the clinical condition of the patient, but is also influenced by the organism isolated, with CVCs generally removed for infections with S. aureus and Candida spp. whereas gram negative infections are associated with better catheter salvage rates . Re‐insertion of a CVC, especially a tunneled one, is associated with the risk of iatrogenic complications like pneumothorax, nerve and soft tissue injury and bleeding, along with the added costs.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

Zanwar

Jain

Gokarn

et al. 2018

Transplant Infectious Dis

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Central venous catheters (CVCs) represent a significant source of infection in patients undergoing hematopoietic stem cell transplantation and can add to the cost of care, morbidity, and mortality. Organisms forming biofilms on the inner surface of catheters require a much higher local antibiotic concentration to clear the pathogen growth. Antibiotic lock therapy (ALT) represents one such strategy to achieve such high intraluminal concentrations of antibiotics and can facilitate catheter salvage. Patients with catheter colonization (CC) or hemodynamically stable catheter‐related bloodstream infection (CRBSI) received ALT per institutional policy. We analyzed the incidence of CC and CRBSI and salvage rate of tunneled CVCs (Hickman) with ALT in patients undergoing hematopoietic stem cell transplant in this retrospective study. Catheter colonization was noted in 9.8% and CRBSI in 10.7% patients. Gram‐negative bacilli (GNB) accounted for 45% and 83% of isolates in CC and CRBSI, respectively. In patients with CRBSI, the rate of catheter salvage with the use of ALT in addition to systemic antibiotics was 86% compared to 55% in patients with systemic antibiotics use only (P = 0.06). There was no CRBSI related mortality, and no increase in resistant strains was noted at subsequent CRBSI. In conclusion, ALT represents an important strategy for catheter salvage, especially for gram‐negative infections, in a carefully selected patient population.

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Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections

Cited by 46 publications

References 11 publications

Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia

Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia

Bacteriological profile and their antimicrobial susceptibility pattern in central venous catheter tip culture

Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

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