title: Catheter removal versus retention in the management of catheter-associated enterococcal bloodstream infections.
abstract: BACKGROUND
  Enterococci are an important cause of central venous catheter (CVC)-associated bloodstream infections (CA-BSI). It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.
  
  
  METHODS
  A 12-month retrospective cohort study of adults with enterococcal CA-BSI was conducted at a tertiary care hospital; clinical, microbiological and outcome data were collected.
  
  
  RESULTS
  A total of 111 patients had an enterococcal CA-BSI. The median age was 58.2 years (range 21 to 94 years). There were 45 (40.5%) infections caused by Entercoccus faecalis (among which 10 [22%] were vancomycin resistant), 61 (55%) by Enterococcus faecium (57 [93%] vancomycin resistant) and five (4.5%) by other Enterococcus species. Patients were treated with linezolid (n=51 [46%]), vancomycin (n=37 [33%]), daptomycin (n=11 [10%]), ampicillin (n=2 [2%]) or quinupristin/dalfopristin (n=2 [2%]); seven (n=6%) patients did not receive adequate enterococcal treatment. Additionally, 24 (22%) patients received adjunctive gentamicin treatment. The CVC was retained in 29 (26.1%) patients. Patients with removed CVCs showed lower rates of in-hospital mortality (15 [18.3%] versus 11 [37.9]; P=0.03), but similar rates of recurrent bacteremia (nine [11.0%] versus two (7.0%); P=0.7) and a similar post-BSI length of hospital stay (median days [range]) (11.1 [1.7 to 63.1 days] versus 9.3 [1.9 to 31.8 days]; P=0.3). Catheter retention was an independent predictor of mortality (OR 3.34 [95% CI 1.21 to 9.26]).
  
  
  CONCLUSIONS
  To the authors' knowledge, the present article describes the largest enterococcal CA-BSI series to date. Mortality was increased among patients who had their catheter retained. Additional prospective studies are necessary to determine the optimal management of enterococcal CA-BSI.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Piccirillo
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.affiliation: Medical Informatics, BJC Healthcare, St Louis, Missouri, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Doherty
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
keywords: Bacteremia; Central venous catheter; Enterococcus; Management