Antibiotics Unnecessary in Coagulase-Negative Staphylococci Catheter-Related BSI

Patients not receiving antibiotics for catheter-related bloodstream infections (CRBSI) with coagulase-negative Staphylococci (CoNS) after catheter removal experience similar short-term complications and long-term recurrences to patients receiving ≥5 days of antibiotic therapy, according study results published in Antimicrobial Resistance & Infection Control.

In this retrospective study, data from patients with CoNS-CRBSI admitted to Bern University Hospital in Switzerland between January 1, 2008 and December 31, 2016 were reviewed. The main inclusion criteria were the removal of a short- or long-term intravascular catheter with a quantitative catheter tip culture growing CoNS and the same CoNS identified in the blood culture of a given patient.

Researchers compared non-resolved infection, defined as either the presence of prolonged bacteremia or symptoms attributed to CoNS-CRBSI >2 days after catheter removal in 2 groups of patients: a treatment group who were prescribed antibiotics ≥5 days according to the current Infectious Diseases Society of America (IDSA) guidelines and a no-treatment group.

Of the 184 patients identified with CoNS-CRBSI, 76% received antibiotic treatment and 17% did not receive treatment. The majority (70%) of the patients were men and 96% of CoNS-CRBSI were hospital-acquired. Median age was 61 years and the mean follow-up time was 234 days. The most frequently administered antibiotic (73%) was vancomycin.

While baselines characteristics were similar in both groups, severe neutropenia, hematologic cancer, and immunosuppression were significantly more frequent in the treatment group vs the no-treatment group (51% vs 3%, 53% vs 6%, 61% vs 16%, respectively; P <.001 for all).

A non-resolved infection was observed in 30 patients, with recurrence being infrequently detected. There were 0% non-resolved infections in the no-treatment group vs 22% in the treatment group (P =.01).

Because of the imbalance between the number of patients in the 2 groups, researchers performed a post-hoc subgroup analysis with 32 matched pairs from each group. The majority of the patients in this subgroup analysis were patients without neutropenia (n=31). The subgroup analysis showed similar results with 0% of non-resolved infections in the no-treatment group vs 15.6% in the treatment group (P =.06).

Researchers noted that the presence of orthopedic hardware or intravascular prosthetic material in 27% of patients did not influence the rate of late recurrences.

While the results may not be applicable to patients with severe neutropenia, they “clearly suggest that managing CoNS-CRBSI without clinical evidence of local symptoms solely with catheter removal appears to be an option with neither short-term complications nor long-term recurrences,” noted the researchers. Future prospective randomized trials are needed to verify the study findings and ensure patient safety, concluded the researchers.

Reference

Hebeisen UP, Atkinson A, Marschall J, Buetti N. Catheter-related bloodstream infections with coagulase-negative staphylococci: are antibiotics necessary if the catheter is removed?Antimicrob Resist Infect Control. 2019;8:21.