Risk Factors for Metastatic Infectious Complications in Patients with Catheter-Related Bloodstream Infection

Background/Objectives: Catheter-related bloodstream infections (CRBSIs) may lead to metastatic complications. However, risk factors for such complications remain insufficiently characterized. This study aims to identify risk factors associated with metastatic infectious complications in patients with CRBSI. Methods: This monocentric cohort study included adult patients with CRBSI due to Gram-positive cocci or Candida spp. (2015-2024). The primary endpoint was the occurrence of metastatic complications, including infective endocarditis, embolic events, bone and joint infections, and vascular graft infections. Results: A total of 1023 CRBSI episodes were included. Staphylococcus aureus was the most common pathogen (331 episodes; 32%), followed by coagulase-negative staphylococci (307; 30%), enterococci (175; 17%), Candida spp. (171; 17%), and streptococci (98; 10%). Metastatic complications occurred in 93 episodes (9%). In multivariable logistic regression, female sex (aOR 1.61; 95% CI 1.02-2.56), S. aureus infection (aOR 1.62; 95% CI 1.01-2.61), community-onset infection (aOR 2.23; 95% CI 1.26-3.95), septic deep vein thrombosis (aOR 2.19; 95% CI 1.04-4.58), and persistent bacteremia ≥ 48 h (aOR 4.54; 95% CI 2.78-7.44) were independently associated with metastatic complications. In the S. aureus subgroup, only persistent bacteremia remained significant (aOR 6.28; 95% 3.12-12.6). Conclusions: Metastatic complications occurred in approximately 9% of CRBSI episodes but were strongly associated with persistent bacteremia, particularly in S. aureus infections. Persistence of bloodstream infection and community-onset presentation should prompt evaluation for metastatic foci.