Central line-associated bloodstream infections caused by Staphylococcus aureus in cancer patients: Clinical outcome and management.
BACKGROUND
There are limited data regarding clinical presentation and management of Staphylococcus aureus central line- associated bloodstream infection (CLABSI) in immunocompromised cancer patients.


METHODS
In this review, we evaluated 299 patients with 304 episodes of S. aureus-CLABSI between 2005 and 2011.


RESULTS
By multivariate analysis, the major predictors of complicated S. aureus-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 (P ≤ 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 (P = 0.024).


CONCLUSIONS
The majority of S. aureus-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.
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA.
Aline
A
El Zakhem
Anne-Marie
AM
Chaftari
Ramez
R
Bahu
Gilbert
G
El Helou
Samuel
S
Shelburne
Ying
Y
Jiang
Ray
R
Hachem
Issam
I
Raad
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000209:etiology / Q000628:therapy*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy*; D013211:Staphylococcus aureus; D055815:Young Adult