title: Persistent catheter-related Staphylococcus aureus bacteremia after catheter removal and initiation of antimicrobial therapy.
abstract: OBJECTIVE
  Catheter-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.
  
  
  METHODS
  Consecutive 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Lee
authors.forename: Hyo-Lim
authors.initials: HL
authors.lastname: Hong
authors.forename: Tark
authors.initials: T
authors.lastname: Kim
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Park
authors.forename: So-Youn
authors.initials: SY
authors.lastname: Park
authors.forename: Song Mi
authors.initials: SM
authors.lastname: Moon
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Chong
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Jeong
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents