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2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis

BACKGROUND: Catheter-related bloodstream infection (CRBSI) is an important complication of long-term central venous catheters (CVCs) and is associated with high morbidity and cost. While line removal is optimal, it is not always feasible and is not without complications. Antibiotic lock therapy (ALT...

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Autores principales: Ranganath, Nischal, Dumais, Mitchell, Nair, Vaisak, Tabaja, Hussam, Stevens, Ryan W W, O’Horo, John C, Shah, Aditya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677183/
http://dx.doi.org/10.1093/ofid/ofad500.2051
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author Ranganath, Nischal
Dumais, Mitchell
Nair, Vaisak
Tabaja, Hussam
Stevens, Ryan W W
O’Horo, John C
Shah, Aditya
author_facet Ranganath, Nischal
Dumais, Mitchell
Nair, Vaisak
Tabaja, Hussam
Stevens, Ryan W W
O’Horo, John C
Shah, Aditya
author_sort Ranganath, Nischal
collection PubMed
description BACKGROUND: Catheter-related bloodstream infection (CRBSI) is an important complication of long-term central venous catheters (CVCs) and is associated with high morbidity and cost. While line removal is optimal, it is not always feasible and is not without complications. Antibiotic lock therapy (ALT) may be an alternative strategy for line salvage, but the efficacy of this approach particularly among immunocompromised hosts is unknown. METHODS: We retrospectively reviewed adult patients with CRBSI managed with ALT between 2018 and 2022 at our tertiary medical center. We reviewed patient comorbidities, type and indications for CVC use, microbiology of CRBSI, ALT, and use of systemic antibiotics. Outcomes included 30-day mortality, 90-day microbiologic relapse (with same bacteria as index case), 90-day recurrent BSI (with different bacteria from index case), and adverse events. RESULTS: 86 patients were reviewed, a majority of whom were immunocompromised (91%) due to hematopoietic stem cell transplantation (85%) and thrombocytopenic (platelet count 36; IQR 17-112). 78% had tunneled CVC for indications including peri-transplant therapy (72%), chemotherapy (15%), and TPN (6%) (Table 1). The median time to CRBSI following CVC insertion was 45 days (IQR 19-86). Infections were frequently monomicrobial (80%) due to Gram-positive organisms (n=75) including coagulase-negative staphylococci and Enterococcus spp. The minority of Gram-negative (n=17) infections were due to E coli and Enterobacter spp. 94% of patients received systemic antibiotics and all patients received ALT for a median of 11 days [IQR 6-15] and 11.5 days [IQR 6-14], respectively (Table 2). The 30-day attributable mortality rate was low at 1%. Rates of 90-day microbiologic relapse (20%) and recurrent BSI (16%) were high, occurring at a median of 42 days (IQR 12-55) and 35 days (IQR 25-50) following completion of ALT, respectively (Table 3). [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: Despite high rates of microbiologic relapse and recurrent BSI, ALT may be an effective line salvage strategy extending the use of CVC by up to 30 days with minimal impact on mortality even among immunocompromised patients. DISCLOSURES: John C. O'Horo, Sr., MD, MPH, Janssen Pharmaceuticals.: Grant/Research Support|nference: Grant/Research Support
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spelling pubmed-106771832023-11-27 2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis Ranganath, Nischal Dumais, Mitchell Nair, Vaisak Tabaja, Hussam Stevens, Ryan W W O’Horo, John C Shah, Aditya Open Forum Infect Dis Abstract BACKGROUND: Catheter-related bloodstream infection (CRBSI) is an important complication of long-term central venous catheters (CVCs) and is associated with high morbidity and cost. While line removal is optimal, it is not always feasible and is not without complications. Antibiotic lock therapy (ALT) may be an alternative strategy for line salvage, but the efficacy of this approach particularly among immunocompromised hosts is unknown. METHODS: We retrospectively reviewed adult patients with CRBSI managed with ALT between 2018 and 2022 at our tertiary medical center. We reviewed patient comorbidities, type and indications for CVC use, microbiology of CRBSI, ALT, and use of systemic antibiotics. Outcomes included 30-day mortality, 90-day microbiologic relapse (with same bacteria as index case), 90-day recurrent BSI (with different bacteria from index case), and adverse events. RESULTS: 86 patients were reviewed, a majority of whom were immunocompromised (91%) due to hematopoietic stem cell transplantation (85%) and thrombocytopenic (platelet count 36; IQR 17-112). 78% had tunneled CVC for indications including peri-transplant therapy (72%), chemotherapy (15%), and TPN (6%) (Table 1). The median time to CRBSI following CVC insertion was 45 days (IQR 19-86). Infections were frequently monomicrobial (80%) due to Gram-positive organisms (n=75) including coagulase-negative staphylococci and Enterococcus spp. The minority of Gram-negative (n=17) infections were due to E coli and Enterobacter spp. 94% of patients received systemic antibiotics and all patients received ALT for a median of 11 days [IQR 6-15] and 11.5 days [IQR 6-14], respectively (Table 2). The 30-day attributable mortality rate was low at 1%. Rates of 90-day microbiologic relapse (20%) and recurrent BSI (16%) were high, occurring at a median of 42 days (IQR 12-55) and 35 days (IQR 25-50) following completion of ALT, respectively (Table 3). [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: Despite high rates of microbiologic relapse and recurrent BSI, ALT may be an effective line salvage strategy extending the use of CVC by up to 30 days with minimal impact on mortality even among immunocompromised patients. DISCLOSURES: John C. O'Horo, Sr., MD, MPH, Janssen Pharmaceuticals.: Grant/Research Support|nference: Grant/Research Support Oxford University Press 2023-11-27 /pmc/articles/PMC10677183/ http://dx.doi.org/10.1093/ofid/ofad500.2051 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Ranganath, Nischal
Dumais, Mitchell
Nair, Vaisak
Tabaja, Hussam
Stevens, Ryan W W
O’Horo, John C
Shah, Aditya
2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
title 2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
title_full 2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
title_fullStr 2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
title_full_unstemmed 2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
title_short 2432. Antibiotic Lock Therapy as a Line Salvage Strategy for Catheter-Related Bloodstream Infections: A Retrospective analysis
title_sort 2432. antibiotic lock therapy as a line salvage strategy for catheter-related bloodstream infections: a retrospective analysis
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677183/
http://dx.doi.org/10.1093/ofid/ofad500.2051
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