Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort.
Journal
The Journal of antimicrobial chemotherapy
ISSN: 1460-2091
Titre abrégé: J Antimicrob Chemother
Pays: England
ID NLM: 7513617
Informations de publication
Date de publication:
01 10 2020
01 10 2020
Historique:
received:
20
02
2020
revised:
04
05
2020
accepted:
16
05
2020
pubmed:
21
7
2020
medline:
25
6
2021
entrez:
21
7
2020
Statut:
ppublish
Résumé
Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances. To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI. Patients with CRBSI were selected from the PROBAC cohort, a prospective, observational, multicentre national cohort study including patients with bloodstream infections consecutively admitted to 26 Spanish hospitals in a 6 month period (October 2016-March 2017). Outcome variables were GNB aetiology and 30 day mortality. Adjusted analyses were performed by logistic regression. Six hundred and thirty-one episodes of CRBSI were included in the study. Risk factors independently related to GNB aetiology were central venous catheter (CVC) [OR 1.60 (95% CI: 1.05-2.44), P = 0.028], sepsis/septic shock [OR: 1.76 (95% CI: 1.11-2.80), P = 0.016], antibiotic therapy in the previous 30 days [OR: 1.56 (95% CI: 1.02-2.36), P = 0.037], neutropenia <500/μL [OR: 2.01 (95% CI: 1.04-3.87), P = 0.037] and peripheral vascular disease [OR: 2.04 (95% CI: 1.13-3.68), P = 0.018]. GNB were not associated with increased mortality in adjusted analysis, while removal of catheter [OR: 0.24 (95% CI: 0.09-0.61), P = 0.002] and adequate empirical treatment [OR: 0.37 (95% CI: 0.18-0.77), P = 0.008] were strong protective factors. Our study reinforces the recommendation that empirical coverage should cover GNB in patients presenting with sepsis/septic shock and in neutropenic patients. Catheter removal and adequate empirical treatment were both protective factors against mortality in patients with CRBSI.
Sections du résumé
BACKGROUND
Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances.
OBJECTIVES
To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI.
METHODS
Patients with CRBSI were selected from the PROBAC cohort, a prospective, observational, multicentre national cohort study including patients with bloodstream infections consecutively admitted to 26 Spanish hospitals in a 6 month period (October 2016-March 2017). Outcome variables were GNB aetiology and 30 day mortality. Adjusted analyses were performed by logistic regression.
RESULTS
Six hundred and thirty-one episodes of CRBSI were included in the study. Risk factors independently related to GNB aetiology were central venous catheter (CVC) [OR 1.60 (95% CI: 1.05-2.44), P = 0.028], sepsis/septic shock [OR: 1.76 (95% CI: 1.11-2.80), P = 0.016], antibiotic therapy in the previous 30 days [OR: 1.56 (95% CI: 1.02-2.36), P = 0.037], neutropenia <500/μL [OR: 2.01 (95% CI: 1.04-3.87), P = 0.037] and peripheral vascular disease [OR: 2.04 (95% CI: 1.13-3.68), P = 0.018]. GNB were not associated with increased mortality in adjusted analysis, while removal of catheter [OR: 0.24 (95% CI: 0.09-0.61), P = 0.002] and adequate empirical treatment [OR: 0.37 (95% CI: 0.18-0.77), P = 0.008] were strong protective factors.
CONCLUSIONS
Our study reinforces the recommendation that empirical coverage should cover GNB in patients presenting with sepsis/septic shock and in neutropenic patients. Catheter removal and adequate empirical treatment were both protective factors against mortality in patients with CRBSI.
Identifiants
pubmed: 32688386
pii: 5874077
doi: 10.1093/jac/dkaa262
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3056-3061Investigateurs
Marta Arias Temprano
(MA)
Jonathan Fernández Suárez
(JF)
Lucía Boix
(L)
Juan Manuel Sánchez Calvo
(JMS)
Jordi Cuquet-Pedragosa
(J)
Fernando Barcenilla-Gaite
(F)
Clara Natera Kindelán
(CN)
Fátima Galán
(F)
Alfonso Del Arco Jiménez
(A)
Alberto Bahamonde
(A)
Alejandro Smithson
(A)
David Vinuesa
(D)
Isabel Gea Lázaro
(IG)
Armando Reyes Bertos
(AR)
Inés Pérez Camacho
(IP)
Antonio Sánchez-Porto
(A)
Marcos Guzmán García
(MG)
Berta Becerril Carral
(BB)
Esperanza Merino de Lucas
(EM)
J Calvo
(J)
M C Fariñas
(MC)
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.