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A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci

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Abstract

CoNS is the main cause of catheter-related bloodstream infections (CRBSI). Current guidelines recommend catheter withdrawal followed by antibiotics for at least 5 days. We aimed to assess the efficacy and safety of a shorter course of antibiotherapy in patients with CoNS CRBSI. All proven cases of CoNS CRBSI at our institution (Jan 12/Dec 17) were retrospectively analysed. Comparison of clinical characteristics and outcomes between patients receiving a short (SC ≤ 3 days) versus long antibiotic course (LC > 3 days) was performed. Cox regression models predicting the risk for complications (including propensity score [PS] for treatment assignment as covariate) were designed to adjust baseline differences among both treatment groups. A total of 79 cases were included. Most patients (75.9%) showed clinical response at day 7 after catheter removal. Complications occurred in 3.8% (three cases of septic thrombophlebitis) with no cases of endocarditis. Microbiological relapse (MR) occurred in 13 patients (16.5%). SC and LC were administered to 25 (31.6%) and 54 (68.4%) patients, respectively, with no significant differences in MR-free survival between SC and LC groups (87.8 vs 86.3%; P = 0.6). In PS-adjusted Cox regression analyses, a tunnelled catheter as the source of CRBSI was the only independent risk factor for MR (hazard ratio, 5.71; 95% confidence interval, 1.6–21) whereas the duration of therapy had no apparent impact. Shortening antibiotic therapy to ≤ 3 days is not associated with a poorer outcome or a greater risk of MR in patients with CoNS CRBI with catheter withdrawal.

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Authors and Affiliations

  1. Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (imas12), University Hospital “12 de Octubre”, Avenida de Córdoba, s/n, 28041, Madrid, Spain

    Rafael San-Juan, Iván Martínez-Redondo, Mario Fernández-Ruiz, María Ruiz-Ruigómez, Laura Corbella, Pilar Hernández-Jiménez, Jose Tiago Silva, Francisco López-Medrano & José María Aguado

  2. Department of Microbiology. University Hospital 12 de Octubre, Instituto de Investigación Hospital “12 de Octubre” (imas12), School of Medicine, Universidad Complutense, Madrid, Spain

    Raúl Recio & María Ángeles Orellana

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  1. Rafael San-Juan
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  2. Iván Martínez-Redondo
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  3. Mario Fernández-Ruiz
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  4. María Ruiz-Ruigómez
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  5. Laura Corbella
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  6. Pilar Hernández-Jiménez
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  7. Jose Tiago Silva
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  8. Francisco López-Medrano
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  9. Raúl Recio
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  10. María Ángeles Orellana
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  11. José María Aguado
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Correspondence to Rafael San-Juan.

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The study was approved by the local ethics research committee.

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In accordance with the local ethics research committee, informed consent was waived due to the retrospective nature of this study.

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San-Juan, R., Martínez-Redondo, I., Fernández-Ruiz, M. et al. A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci. Eur J Clin Microbiol Infect Dis 38, 977–983 (2019). https://doi.org/10.1007/s10096-019-03545-8

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  • DOI: https://doi.org/10.1007/s10096-019-03545-8

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