Central venous catheter-related bacteremia due to gram-negative bacilli: significance of catheter removal in preventing relapse.
OBJECTIVE
To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal.


METHODS
This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records.


METHODS
University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.


METHODS
Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills).


RESULTS
Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02-0.75; P = .02).


CONCLUSIONS
In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.
Hanna
Hend
H
The University of Texas M. D. Anderson Cancer Center, Department of Infectious Diseases, Infection Control and Employee Health (Unit 402), 1515 Holcombe Blvd., Houston, TX 77030, USA.
Afif
Claude
C
Alakech
Badie
B
Boktour
Maha
M
Tarrand
Jeffrey
J
Hachem
Ray
R
Raad
Issam
I
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D020878:Device Removal; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention
D000900:Anti-Bacterial Agents