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A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci

  • Rafael San-JuanEmail author
  • Iván Martínez-Redondo
  • Mario Fernández-Ruiz
  • María Ruiz-Ruigómez
  • Laura Corbella
  • Pilar Hernández-Jiménez
  • Jose Tiago Silva
  • Francisco López-Medrano
  • Raúl Recio
  • María Ángeles Orellana
  • José María Aguado
Original Article

Abstract

CoNS is the main cause of catheter-related bloodstream infections (CRBSI). Current guidelines recommend catheter withdrawal followed by antibiotics for at least 5 days. We aimed to assess the efficacy and safety of a shorter course of antibiotherapy in patients with CoNS CRBSI. All proven cases of CoNS CRBSI at our institution (Jan 12/Dec 17) were retrospectively analysed. Comparison of clinical characteristics and outcomes between patients receiving a short (SC ≤ 3 days) versus long antibiotic course (LC > 3 days) was performed. Cox regression models predicting the risk for complications (including propensity score [PS] for treatment assignment as covariate) were designed to adjust baseline differences among both treatment groups. A total of 79 cases were included. Most patients (75.9%) showed clinical response at day 7 after catheter removal. Complications occurred in 3.8% (three cases of septic thrombophlebitis) with no cases of endocarditis. Microbiological relapse (MR) occurred in 13 patients (16.5%). SC and LC were administered to 25 (31.6%) and 54 (68.4%) patients, respectively, with no significant differences in MR-free survival between SC and LC groups (87.8 vs 86.3%; P = 0.6). In PS-adjusted Cox regression analyses, a tunnelled catheter as the source of CRBSI was the only independent risk factor for MR (hazard ratio, 5.71; 95% confidence interval, 1.6–21) whereas the duration of therapy had no apparent impact. Shortening antibiotic therapy to ≤ 3 days is not associated with a poorer outcome or a greater risk of MR in patients with CoNS CRBI with catheter withdrawal.

Keywords

Coagulase-negative Staphylococcus Catheter-related bloodstream infection Short antibiotic course Outcome Relapse 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethics research committee.

Informed consent

In accordance with the local ethics research committee, informed consent was waived due to the retrospective nature of this study.

References

  1. 1.
    Wenzel RP, Edmond MB (2006) Team-based prevention of catheter-related infections. N Engl J Med 355(26):2781–2783CrossRefGoogle Scholar
  2. 2.
    Sociedad Española de Medicina Preventiva SPeH (2017) Estudio EPINE-EPPS 2017, http://hws.vhebron.net/epine/Global/EPINE-EPPS%202017%20Informe%20Global%20de%20Espa%C3%B1a%20Resumen.pdf Cited May 2018 2018
  3. 3.
    Rogers KL, Fey PD, Rupp ME (2009) Coagulase-negative staphylococcal infections. Infect Dis Clin N Am 23(1):73–98CrossRefGoogle Scholar
  4. 4.
    Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Dominguez MA, Esteban J, Fernandez-Hidalgo N, Fernandez Sampedro M, Fortun J, Guembe M, Lorente L, Pano JR, Ramirez P, Salavert M, Sanchez M, Valles J (2018) Diagnosis and treatment of catheter-related bloodstream infection: clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Int 42(1):5–36Google Scholar
  5. 5.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45CrossRefGoogle Scholar
  6. 6.
    Corey GR, Stryjewski ME, Everts RJ (2009) Short-course therapy for bloodstream infections in immunocompetent adults. Int J Antimicrob Agents 34(Suppl 4):S47–S51CrossRefGoogle Scholar
  7. 7.
    McCabe WR, Jackson GG (1960) Treatment of chronic pyelonephritis. III. Comparison of several drugs combined and one member of the combination, colistin. Am J Med Sci 240:754–763CrossRefGoogle Scholar
  8. 8.
    Charlson ME, Sax FL, MacKenzie CR, Braham RL, Fields SD, Douglas RG Jr (1987) Morbidity during hospitalization: can we predict it? J Chronic Dis 40(7):705–712CrossRefGoogle Scholar
  9. 9.
    Chow JW, Yu VL (1999) Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 11(1):7–12CrossRefGoogle Scholar
  10. 10.
    Raad I, Davis S, Khan A, Tarrand J, Elting L, Bodey GP (1992) Impact of central venous catheter removal on the recurrence of catheter-related coagulase-negative staphylococcal bacteremia. Infect Control Hosp Epidemiol 13(4):215–221CrossRefGoogle Scholar
  11. 11.
    Raad I, Kassar R, Ghannam D, Chaftari AM, Hachem R, Jiang Y (2009) Management of the catheter in documented catheter-related coagulase-negative staphylococcal bacteremia: remove or retain? Clin Infect Dis 49(8):1187–1194CrossRefGoogle Scholar
  12. 12.
    Park SY, Kwon KH, Chung JW, Huh HJ, Chae SL (2015) Coagulase-negative staphylococcal bacteremia: risk factors for mortality and impact of initial appropriate antimicrobial therapy on outcome. Eur J Clin Microbiol Infect Dis 34(7):1395–1401CrossRefGoogle Scholar
  13. 13.
    Holland TL, Raad I, Boucher HW, Anderson DJ, Cosgrove SE, Aycock PS, Baddley JW, Chaftari AM, Chow SC, Chu VH, Carugati M, Cook P, Corey GR, Crowley AL, Daly J, Gu J, Hachem R, Horton J, Jenkins TC, Levine D, Miro JM, Pericas JM, Riska P, Rubin Z, Rupp ME, Schrank J Jr, Sims M, Wray D, Zervos M, Fowler VG Jr, Staphylococcal Bacteremia I (2018) Effect of algorithm-based therapy vs usual care on clinical success and serious adverse events in patients with Staphylococcal Bacteremia: a randomized clinical trial. JAMA 320(12):1249–1258CrossRefGoogle Scholar
  14. 14.
    Lalueza A, Morales-Cartagena A, Chaves F, San Juan R, Laureiro J, Lora-Tamayo J, Lopez-Medrano F, Orellana MA, Aguado JM (2015) Risk factors for metastatic osteoarticular infections after a long follow-up of patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect 21(11):1010 e1011-1015Google Scholar
  15. 15.
    Molina J, Penuela I, Lepe JA, Gutierrez-Pizarraya A, Gomez MJ, Garcia-Cabrera E, Cordero E, Aznar J, Pachon J (2013) Mortality and hospital stay related to coagulase-negative Staphylococci bacteremia in non-critical patients. J Infect 66(2):155–162CrossRefGoogle Scholar
  16. 16.
    Olaechea PM, Alvarez-Lerma F, Palomar M, Insausti J, Lopez-Pueyo MJ, Martinez-Pellus A, Canton ML (2011) Impact of primary and intravascular catheter-related bacteremia due to coagulase-negative staphylococci in critically ill patients. Med Int 35(4):217–225Google Scholar
  17. 17.
    Hemels MA, van den Hoogen A, Verboon-Maciolek MA, Fleer A, Krediet TG (2012) Shortening the antibiotic course for the treatment of neonatal coagulase-negative staphylococcal sepsis: fine with three days? Neonatology 101(2):101–105CrossRefGoogle Scholar
  18. 18.
    Yamada K, Namikawa H, Fujimoto H, Nakaie K, Takizawa E, Okada Y, Fujita A, Kawaguchi H, Nakamura Y, Abe J, Kaneko Y, Kakeya H (2017) Clinical characteristics of methicillin-resistant coagulase-negative Staphylococcal Bacteremia in a tertiary hospital. Intern Med 56(7):781–785CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rafael San-Juan
    • 1
    Email author
  • Iván Martínez-Redondo
    • 1
  • Mario Fernández-Ruiz
    • 1
  • María Ruiz-Ruigómez
    • 1
  • Laura Corbella
    • 1
  • Pilar Hernández-Jiménez
    • 1
  • Jose Tiago Silva
    • 1
  • Francisco López-Medrano
    • 1
  • Raúl Recio
    • 2
  • María Ángeles Orellana
    • 2
  • José María Aguado
    • 1
  1. 1.Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (imas12)University Hospital “12 de Octubre”MadridSpain
  2. 2.Department of Microbiology. University Hospital 12 de Octubre, Instituto de Investigación Hospital “12 de Octubre” (imas12), School of MedicineUniversidad ComplutenseMadridSpain

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