Details

Autor(en) / Beteiligte

• Calò, Federica
• Retamar, Pilar
• Martínez Pérez-Crespo, Pedro María
• Lanz-García, Joaquín
• Sousa, Adrian
• Goikoetxea, Josune
• Reguera-Iglesias, José María
• León, Eva
• Armiñanzas, Carlos
• Mantecón, Maria Angeles
• Rodríguez-Baño, Jesús
• López-Cortés, Luis Eduardo

Titel

Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort

Ist Teil von

• Journal of antimicrobial chemotherapy, 2020-10, Vol.75 (10), p.3056-3061

Ort / Verlag

England

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• 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.