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Central venous catheter-related bloodstream infections: Epidemiology and risk factors for hematogenous complications
Elisabeth Carolle Ngo Bell1, Virginie Chapon2, Emilie Bessede3
1Centre Hospitalier d'Angoulême, Service de Médecine interne, F-16000 Angoulême, France.
Insights
Central catheter-related bloodstream infections (CRBIs) can cause serious complications. Persistent bacteremia, especially from Staphylococcus aureus (SA), and hemodialysis increase complication risks, necessitating thorough investigation.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Critical Care Medicine
Background:
- Central catheter-related bloodstream infections (CRBIs) are associated with severe complications like suppurative thrombophlebitis, endocarditis, and metastatic infections.
- While Staphylococcus aureus (SA) CRBI complications are known, data on other bacterial causes are limited.
Purpose of the Study:
- To investigate hematogenous complications of CRBIs based on patient characteristics, central venous catheter (CVC) types, and causative bacteria.
- To identify risk factors for hematogenous complications and mortality in CRBI patients.
Main Methods:
- A 2-year retrospective single-center study included 254 patients with confirmed CRBIs.
- Data collected included patient demographics, CVC types, isolated bacteria, and occurrence of hematogenous complications.
- Multivariate analysis was used to identify risk factors for complications and mortality.
Main Results:
- Enterobacteriaceae, coagulase-negative Staphylococci (CNS), SA, and non-fermenting Gram-negative bacteria (NGB) were the main causative agents.
- 14% of patients developed hematogenous complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections.
- Hemodialysis, persistent bacteremia (≥3 days), and SA CRBIs increased complication risk; anticoagulant treatment reduced risk. Diabetes, CVC maintenance, and complications increased 3-month mortality.
Conclusions:
- Patients with persistent bacteremia, particularly those with SA infections or on hemodialysis, require thorough investigation for hematogenous complications.
- Early identification and management of risk factors are crucial for improving outcomes in CRBI patients.
Background:
Central catheter-related bloodstream infections (CRBIs) can lead to severe complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections. While complications due to CRBIs caused by Staphylococcus aureus (SA) are well-known, there are limited data regarding CRBIs caused by other bacteria.
Methods:
This 2-year retrospective single-center study of patients with CRBIs from a tertiary care hospital examined the hematogenous complications associated with CRBIs according to patient characteristics, central venous catheter (CVC) types, and causative bacteria.
Results:
All in all, 254 patients with confirmed CRBIs were included; 285 bacteria types were isolated, mainly Enterobacteriaceae (n = 94), coagulase-negative Staphylococci (CNS, n = 82), SA (n = 45), and non-fermenting Gram-negative bacteria (NGB, n = 45). Among the patients, 35 developed at least one hematogenous complication (14 %), including suppurative thrombophlebitis (n = 15), endocarditis (n = 7) and metastatic infections (n = 16). In multivariate analysis, hemodialysis, persistent bacteremia for at least 3 days, and CRBIs caused by SA were associated with increased risk for hematogenous complications, while previous curative anticoagulant treatment was associated with reduced risk. Diabetes, CVC maintenance, and hematogenous complications were associated with increased 3-month mortality.
Conclusion:
A thorough investigation of hematogenous complications should be envisioned in patients with persistent bacteremia, particularly those with SA infections and those on hemodialysis.
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