Central line-associated bloodstream infections caused by Staphylococcus aureus in cancer patients: Clinical outcome and management. (May 2014)

• Record Type: Journal Article
• Authors: El Zakhem, Aline; Chaftari, Anne-Marie; Bahu, Ramez; El Helou, Gilbert; Shelburne, Samuel; Jiang, Ying; Hachem, Ray; Raad, Issam
• Is Part Of: Annals of medicine. Volume 46:Number 3(2014)
• Page Start: 163
• Page End: 168
• Publication Date: 2014-05
• Subjects: Medicine -- Periodicals; 610
• DOI: 10.3109/07853890.2013.878513
• Languages: English
• ISSNs: 0785-3890

Abstract

<abstract> <title>Abstract</title> <p> <italic>Background.</italic> There are limited data regarding clinical presentation and management of <italic>Staphylococcus aureus</italic> central line- associated bloodstream infection (CLABSI) in immunocompromised cancer patients.</p> <p> <italic>Methods.</italic> In this review, we evaluated 299 patients with 304 episodes of <italic>S. aureus</italic><bold>-</bold>CLABSI between 2005 and 2011.</p> <p> <italic>Findings.</italic> By multivariate analysis, the major predictors of complicated <italic>S. aureus</italic>-CLABSI were septic shock, catheter site inflammation, presence of peripherally inserted central catheter, anti-cancer chemotherapy within 10 days, and persistent bacteremia beyond 72 hours (<italic>P ≤</italic> 0.02). A total of 67% of the cases were defined as complicated. In the subset of patients who were uncomplicated on presentation, patients receiving antimicrobials ≥ 14 days had similar rates of relapse, attributable mortality, and development of complications compared to those receiving shorter-course therapy. By competing risk analysis, removal of the catheter within 3 days of the onset of bacteremia was associated with a lower relapse rate at 90 days (<italic>P = </italic>0.024).</p> <p> <italic>Interpretation.</italic> The majority of <italic>S. aureus-</italic>CLABSI in cancer patients are complicated and require prolonged course of antimicrobial treatment. Early removal of the catheter within the first 3 days is associated with better course. In patients with prompt removal of the catheter and no evidence of a complicated course, treatment beyond 2 weeks may not be necessary.</p> </abstract>