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Management of Bacillus bacteremia: the need for catheter removal
Rawan Kassar1, Ray Hachem, Ying Jiang
1From Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
Insights
Removing central venous catheters (CVCs) is crucial for treating Bacillus catheter-related bloodstream infections (CRBSIs). Retaining CVCs significantly increases infection recurrence, while non-vancomycin antibiotics may shorten hospital stays.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Hematology/Oncology
Background:
- Bacillus species are known for biofilm formation, contributing to catheter-related bloodstream infections (CRBSIs).
- Optimal treatment strategies for Bacillus CRBSIs, particularly concerning catheter management and antibiotic choice, remain unclear.
Purpose of the Study:
- To evaluate the impact of central venous catheter (CVC) removal versus retention on Bacillus CRBSI outcomes.
- To compare the effectiveness of vancomycin versus other antibiotic agents in treating Bacillus CRBSIs.
Main Methods:
- Retrospective review of medical records for cancer patients with Bacillus bacteremia from December 1990 to March 2008.
- Defined true bacteremia and Bacillus CRBSI according to established clinical guidelines.
- Analyzed antibiotic susceptibility, recurrence rates, and patient outcomes based on treatment and CVC management.
Main Results:
- Out of 94 Bacillus bacteremia episodes, 93 were CRBSIs (28% definite, 71% probable).
- Catheter retention was associated with a significantly higher recurrence rate (p = 0.028).
- No recurrences were observed in patients whose CVCs were removed.
Conclusions:
- Catheter retention is a significant risk factor for Bacillus CRBSI recurrence.
- Non-vancomycin antibiotic treatment in retained CVC cases correlated with shorter post-infection hospitalization.
- These findings suggest CVC removal is key, and antibiotic choice may influence outcomes in retained CVC scenarios.
Abstract:
Bacillus species are biofilm-forming organisms that are associated with Bacillus catheter-related bloodstream infections (CRBSIs). The optimal treatment of Bacillus CRBSIs is not known. Therefore, in the current study, we determined the role of long-term central venous catheter (CVC) removal and treatment with vancomycin compared with other agents in Bacillus CRBSIs by retrospectively reviewing the medical records of cancer patients with Bacillus bacteremia who had been treated at our institution from December 1990 to March 2008. True bacteremia was defined as a positive blood culture (>15 colony-forming units/mL) with signs and symptoms of infection (such as fever and chills). Bacillus CRBSI was defined in accordance with the Infectious Diseases Society of America guidelines as probable or definite. There were 94 Bacillus bacteremia episodes, 93 of which (99%) were Bacillus CRBSIs (28% definite and 71% probable). Neutropenia during bacteremia occurred in 29%. Almost all bacteremia patients (99%) had been treated with antibiotics; 63% had received vancomycin. Sepsis with hypotension occurred in 6%, and endocarditis in 1%. Bacillus isolates were susceptible to linezolid (100%), vancomycin (98%), tetracycline (77%), and rifampin (67%). All 4 recurrences occurred in patients in whom the CVC had not been removed (12%), whereas no recurrences occurred in patients whose CVC had been removed (p = 0.028). Patient outcome, in terms of fever and hospitalization duration after the infection, was similar in patients who had received < or =10 days of systemic antibiotics compared with patients who had received >10 days. In conclusion, catheter retention in patients with Bacillus CRBSIs is associated with a significantly higher recurrence rate. If the CVC is retained, treatment with non-vancomycin antibiotics is associated with significantly shorter hospitalization duration after the infection, which may be because glycopeptide antibiotics have poor activity against bacilli embedded in biofilm.
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