Abstract
ObjectivesCatheter-related Staphylococcus aureus bacteremia (CRSAB) occasionally persists despite catheter removal and initiation of appropriate antimicrobial therapy. The aim of this study was to determine the incidence, risk factors, and outcomes of persistent CRSAB after catheter removal and initiation of antimicrobial therapy.MethodsConsecutive patients with CRSAB were prospectively included from over a 41-month period. We compared the clinical features, 40 bacterial virulence genes, and outcomes between patients with persistent CRSAB (i.e., bacteremia for >3 days after catheter removal and initiation of appropriate antimicrobial therapy) and non-persistent CRSAB.ResultsAmong the 220 episodes of CRSAB, the catheter was kept in place in 17 (6%) and removed in 203 (94%) cases. In 43 (21%) of the 203 episodes, bacteremia persisted for >3 days after catheter removal and initiation of antimicrobial therapy. Methicillin resistance (Odds ratio [OR], 9.01; 95% confidence interval [CI], 3.05–26.61; P<0.001), non-catheter prosthetic devices (OR, 5.37; 95% CI, 1.62–17.80; P = 0.006), and renal failure (OR, 3.23; 95% CI, 1.48–7.08; P = 0.003) were independently associated with persistent CRSAB. Patients with persistent CRSAB were more like to experience complication than were those with non-persistent CRSAB (72% vs. 15%; P<0.001). Among all episodes due to methicillin-resistant S. aureus, persistent CRSAB isolates were associated with accessory gene regulator (agr) group II (P = .04), but presence of other bacterial virulence genes, distribution of vancomycin minimum inhibitory concentration distribution, and frequency of vancomycin heteroresistance did not differ between the groups.ConclusionsIn patients with CRSAB, bacteremia persisted in 21% of cases despite catheter removal and initiation of antimicrobial therapy. Methicillin resistance, renal failure, and non-catheter prosthetic devices were independent risk factors for persistent CRSAB, which was associated with a higher rate of complications.
Highlights
Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections worldwide, and intravascular catheters are the most common source of these infections, especially in hospitalized patients [1]
A previous study of 37 patients with Catheter-related S. aureus bacteremia (CRSAB) showed that fever and/or bacteremia that persisted for .3 days after catheter removal and/or initiation of antimicrobial therapy was associated with development of early complications [4]
Risk Factors Associated with Persistent CRSAB Of the 203 episodes of CRSAB in which the catheters were removed, bacteremia persisted for .3 days after catheter removal and initiation of appropriate antimicrobial therapy in 43 patients (21%)
Summary
Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections worldwide, and intravascular catheters are the most common source of these infections, especially in hospitalized patients [1]. Bacteremia may persist and complication may develop during the course of therapy if an infected catheter is not removed or if the initiation of antimicrobial therapy is delayed [4,5]. CRSAB occasionally persists despite catheter removal and initiation of appropriate antimicrobial therapy. There is limited literature evaluating the clinical characteristics and outcomes of patients with persistent CRSAB despite initiation of appropriate therapy. A previous study of 37 patients with CRSAB showed that fever and/or bacteremia that persisted for .3 days after catheter removal and/or initiation of antimicrobial therapy was associated with development of early complications [4]. The aim of this study was to determine the incidence, risk factors, and outcomes of persistent CRSAB after catheter removal and initiation of appropriate antimicrobial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
