Abstract
BackgroundInfectious Diseases Society of America (IDSA) guidelines suggest 7–14 days’ duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). The objectives of this study were to review microbial epidemiology, to determine rate and risk factors for relapse, and to compare clinical outcomes in patients receiving long- versus short-duration antibiotic therapy.MethodsA retrospective phase 1 study was conducted between January 2010 and October 2016 to review microbial epidemiology and to determine the incidence of and risk factors for relapse in patients with GNB CRBSI, according to the IDSA guidelines diagnostic criteria. In phase 2 of the study, patients without risk factors for relapse between November 2016 and October 2017 were prospectively recruited to receive antibiotic therapy for 7 days after catheter removal. Matched patients from the retrospective phase 1 study who had received antibiotic therapy for ≥14 days were selected as a phase 2 control group to compare outcomes.ResultsIn phase 1, three most common pathogens identified among 174 cases were Pseudomonas aeruginosa (22.0%), Klebsiella pneumoniae (16.7%), and Stenotrophomonas maltophilia (13.4%). Eighty-nine episodes of infection occurred while patients were receiving antibiotic therapy. Of 140 cases, the relapse rate was 6.4%. Catheter retention was the only risk factor strongly associated with relapse (odds ratio = 145.32; 95% confidence interval 12.66–1667.37, P < 0.001). In phase 2, 11 patients with catheter removal were prospectively recruited to receive short-duration therapy. The number of patients with relapse receiving long- or short-duration therapy was 1 (3%) and 0 (0%), respectively (P = 1.000).ConclusionsFor the management of patients with uncomplicated GNB CRBSI, empiric broad-spectrum antibiotic therapy with adequate coverage of P. aeruginosa should be chosen. Catheter removal should be performed to prevent relapse and shortening the duration of treatment could be considered.Trial registrationThai Clinical Trial Registry: TCTR20190914001. Retrospectively registered on 13 September 2019.
Highlights
Infectious Diseases Society of America (IDSA) guidelines suggest 7–14 days’ duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI)
Three most common pathogens associated with nosocomial infections were P. aeruginosa (23.2%), Klebsiella pneumoniae (17.2%), and Acinetobacter baumannii (15.2%)
During the 7-year duration of the phase 1 study, there were 174 cases of patients with GNB CRBSI. This low number of cases was due to the strict IDSA diagnostic criteria used, which required laboratory evidence to confirm that the catheter was the source of infection [8], which is different from many studies that use central lineassociated bloodstream infection (CLABSI) definition
Summary
Infectious Diseases Society of America (IDSA) guidelines suggest 7–14 days’ duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). For the treatment of uncomplicated GNB CRBSI, the clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection by the Infectious Diseases Society of America (IDSA) suggests antibiotic therapy of 7–14 days [8]. This treatment recommendation came from expert opinions, which is different from recommendations for Grampositive CRBSI that were based on stronger and better quality of evidence [8]. The objectives of this study were to review microbial epidemiology to determine relapse rates, and to identify patients with low risk for relapse, as potential candidates for short-duration antibiotic therapy
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