NEW YORK (Reuters Health) – Whether the catheter is removed or not has no bearing on the resolution of catheter-related coagulase-negative staphylococcal bacteremia following treatment with antimicrobial therapy, according to a report in Clinical Infectious Diseases for October 15.

Retention of the catheter does, however, greatly increase the odds of bacteremia recurrence, Dr. Issam Raad, from M. D. Anderson Cancer Center, Houston, and colleagues found.

“Studies and guidelines recommending the retention of the central venous catheter (CVC) in patients with coagulase-negative staphylococcal bacteremia were based on loose definitions of bacteremia and/or did not evaluate the risk of recurrence,” the authors explain. “In this study, we used strict definitions of coagulase-negative staphylococcal bacteremia to determine the impact of CVC retention on response to and recurrence of infection.”

The study involved 188 patients with catheter-related coagulase-negative staphylococcal bacteremia who were seen at M. D. Anderson from July 2005 to December 2007.

The researchers used the Centers for Disease Control and Prevention’s definition of bacteremia that requires two positive blood culture results. Confirmation of catheter-related bacteremia was based on differential quantitative blood cultures (at least 3:1) or time to positive (>2 hours).

Within 48 hours of antimicrobial therapy, 175 patients (93%) had cleared their infection, the report indicates. Further analysis showed that resolution rates were comparable in patients with a retained catheter versus those with a removed or exchanged catheter.

A stay in the intensive care unit and the presence of other infection sites increased the likelihood of failed treatment by 7.0- and 3.8-fold, respectively.

On multivariate analysis, patients with a retained catheter were six times more likely to experience an infection recurrence than were those with a removed or exchanged catheter (p = 0.004). The duration of antimicrobial therapy did not influence recurrence.

Further research, the authors conclude, is needed to explore various salvage interventions in patients for whom coagulase-negative staphylococcal bacteremia develops, but catheter removal is not possible, such as those with limited vascular access or a hypocoagulable state.

Reference:
Clin Infect Dis 2009;49:1187-1194.