Catheter-related bloodstream infection with coagulase-negative staphylococci in hematological malignancy

Central venous catheters (CVC) are vital in the management of hematological malignancy and complications lead to delayed care and increased costs. Coagulase-negative staphylococci (CoNS) catheter-related bloodstream infection (CRBSI) are common, and the safety of line retention in these infections is unclear.

This single-center retrospective review of individuals with CoNS CRBSI and hematological malignancy between January 1, 2012, and January 1, 2024 compared 90-day all-cause mortality and microbiological relapse in patients managed with CVC retention versus removal. Propensity-weighted analysis was performed to control for baseline differences between groups.

A total of 140 individual cases were included, with 68% (n = 95) having a history of haematopoietic cell transplantation (HCT). 80.4% (n = 111) were neutropenic at the time of CRBSI diagnosis. The predominant CoNS isolated was Staphylococcus epidermidis (n = 124, 88.6%). Bacteraemia with an oxacillin-resistant organism represented 126 (90.0%) of the cases. CVC retention was more common in those with HCT (p = 0.007), while removal was more frequent with peripherally inserted central catheters (PICC)(p < 0.001) and in those hospitalised for CRBSI management (p = 0.022). Clearance of bacteraemia occurred after a median of two days for both retention and removal groups. Propensity weighted analysis demonstrated a significantly higher rate of relapse with CVC retention compared to CVC removal (hazard ratio [HR] = 6.1; p = 0.043), whereas the difference in mortality was not statistically significant (HR = 1.8; p = 0.128).

Clinicians should be vigilant for risks associated with CoNS CRBSI. Future prospective studies evaluating the implications of clinical decision-making in these infections are needed.