Catheter-Related Staphylococcus aureus Bacteremia and Septic Thrombosis: The Role of Anticoagulation Therapy and Duration of Intravenous Antibiotic Therapy.

Rita Wilson Dib,Ray Y Hachem,Anne-Marie Chaftari,Ying Yuan,Issam I Raad,Dima Dandachi

doi:10.1093/ofid/ofy249

Abstract

BackgroundCatheter-related septic thrombosis is suspected in patients with persistent central line–associated bloodstream infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. The clinical diagnosis and management of this entity can be challenging as limited data are available. We retrospectively studied the clinical characteristics of patients with Staphylococcus aureus catheter-related septic thrombosis and the outcomes related to different management strategies.MethodsThis retrospective study included patients with CLABSI due to S. aureus who had concomitant radiographic evidence of catheter site thrombosis treated at our institution between the years 2005 and 2016. We collected data pertaining to patients’ medical history, clinical presentation, management, and outcome within 3 months of bacteremia onset.ResultsA total of 128 patients were included. We found no significant difference in overall outcome between patients who had deep vs superficial thrombosis. Patients with superficial thrombosis were found to have a higher rate of pulmonary complications (25% vs 6%; P = .01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs 5%; P = .001). A multivariate logistic regression analysis identified 2 predictors of treatment failure: ICU admission during their illness (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.08–6.99; P = .034) and not receiving anticoagulation therapy (OR, 0.24; 95% CI, 0.11–0.54; P < .001).ConclusionsOur findings suggest that the presence of S. aureus CLABSI in the setting of catheter-related thrombosis may warrant prolonged intravascular antimicrobial therapy and administration of anticoagulation therapy in critically ill cancer patients.

Highlights

Catheter-related septic thrombosis is suspected in patients with persistent central line–associated bloodstream infection (CLABSI) after 72 hours of appropriate antimicrobial therapy
A multivariate logistic regression analysis identified 2 predictors of treatment failure: intensive care unit (ICU) admission during their illness and not receiving anticoagulation therapy (OR, 0.24; 95% confidence interval (CI), 0.11–0.54; P < .001)
Our findings suggest that the presence of S. aureus CLABSI in the setting of catheter-related thrombosis may warrant prolonged intravascular antimicrobial therapy and administration of anticoagulation therapy in critically ill cancer patients

Summary

Methods

This retrospective study included patients with CLABSI due to S. aureus who had concomitant radiographic evidence of catheter site thrombosis treated at our institution between the years 2005 and 2016. In this retrospective study, we reviewed the medical records of all patients with S. aureus CLABSI treated at The University of Texas MD Anderson Cancer Center from December 2005 to December 2016. CLABSI is defined as a laboratory-confirmed bloodstream infection (not related to an infection at another site) where a central line has been in place for at least 48 hours before the development of bacteremia [10]. Patients who had concomitant radiographic evidence of thrombosis along the catheter around the time of S. aureus bloodstream infection were included.

Results

Discussion

Conclusion