Outcomes Following Early Catheter Removal After Onset of Enterococcal CLABSI in Patients With Cancer

In patients with cancer who have enterococcal central line-associated bloodstream infections (CLABSI), the removal of central venous catheters (CVCs) within 3 days of bacteremia onset may be associated with better outcomes, according to unconfirmed findings published in BMC Infectious Diseases.

Enterococcus species are the third most common cause of CLABSI,  and the incidence of enterococcal CLABSI has increased among patients with cancer. The best strategy for  CVC management among this patient population has not yet been determined; however, current guidelines recommend the removal of long-term CVCs or the administration of antibiotic lock therapy if CVCs must be retained.

A team of investigators conducted a retrospective cohort study to “evaluate the management of Enterococcus species blood-stream infections and their outcomes in cancer patients by comparing patients with CLABSI to those with non-CLABSI.”

Between September 2011 and December 2018, 542 cases of enterococcal bacteremia were identified at The University of Texas MD Anderson Cancer Center. Of these, a total of 397 patients with long-term CVCs were included in the study and divided into 3 groups: group 1 (n=132) had CLABSI with mucosal barrier injury, group 2 (n=101) had either CLABSI without mucosal barrier injury or catheter-related bloodstream infections, and group 3 (n=164) did not have CLABSI but likely developed bacteremia from another source.

Compared with patients in groups 2 and 3, those in group 1 were more likely to have hematologic malignancies (P <.0001 for both). Patients in group 1 also had significantly increased rates of neutropenia (96%) compared with those in groups 2 and 3 (15% and 52%, respectively; P <.0001 for all). Compared with group 3 (23%), patients in group 1 (37%; P =.007) and group 2 (45%; P <.001) were more likely to be recipients of hematopoietic stem cell transplants. The number of patients admitted to the intensive care unit was not significantly different between the 3 groups.

The removal of CVCs was most prevalent among patients in group 2 (55%) as opposed to those in group 1 (48%) and group 3 (36%), and the difference between group 2 and 3 was significant (P <.001). Early CVC removal (<3 days of bacteremia onset) was more common among patients in group 2 compared with those in group 3 (33% vs 20%; P <.01). The differences in all-cause mortality, infection-related mortality within 90 days of initial bacteremia onset, and microbiologic recurrence within 90 days of microbiologic resolution were not found to be statistically significant among the 3 groups.

Among patients in group 1, early CVC removal was associated with better overall outcomes compared with removal between days 3 and 7 (78% vs 67%; P =.003); however, outcomes were similar compared with those whose CVCs were retained (removal >7 days after bacteremia onset).

In contrast to patients in group 1, outcomes seemed to be better among patients in group 2 who underwent CVC removal 3 to 7 days after initial onset of bacteremia (88% vs 63%); however, outcomes were similar compared with those whose CVCs were retained. The investigators noted that among patients in group 3, CVC retention was significantly associated with improved outcomes compared with early CVC removal (90% vs 64%; P =.006).

“Optimum catheter management in such infections is yet to be fully defined,” the authors noted.

“Further prospective data are needed to determine the best approach,” concluded the investigators.

Reference

Awadh H, Chaftari AM, Khalil M, et al. Management of enterococcal central line-associated bloodstream infections in patients with cancer. BMC Infect Dis. 2021;21(1):643. doi:10.1186/s12879-021-06328-9