The early removal of central venous catheters (CVCs) may be favorable when managing central line-associated bloodstream infections (CLABSI) caused by Enterococcus spp, according to a study recently presented at IDWeek 2019, held from October 2 to October 6 in Washington, DC.
In 2014, a report issued by the United States Center for Disease Control and Prevention (CDC) stated that the rise in cases of CLABSI due to Enterococcus spp resulted in these pathogens becoming the third most common causative organism of such infections. Central lines, also known as a CVCs, are commonly used to provide fluids, medications, or blood, and can also be utilized for quick medical tests. However, in the 2009 Infectious Diseases Society of America (IDSA) management guidelines, CVC need and timing of removal is not well defined for Enterococcus-related bacteremia, due to a lack of data. Therefore, this retrospective chart review investigated the effects of early CVC removal in the management of CLABSI.
Between 2010 and 2018, the charts of 543 patients who had been diagnosed with Enterococcus-related bacteremia were reviewed. Inclusion criteria was composed of the presence of an indwelling CVC with no mucosal barrier injury. A total of 180 patients were further evaluated: 90 patients with Enterococcus-related bacteremia who met the CDC definition for CLABSI without mucosal barrier injury or the IDSA definition for catheter-related bloodstream infections, and 90 patients with an indwelling CVC in place with documented non-CLABSI from another source.
Results suggested that in the CLABSI group, early CVC removal had a favorable patient outcomes. Compared with the non-CLABSI group, CVC removal within 3 days of Enterococcus-related bacteremia was significantly higher in the CLABSI without mucosal barrier injury/catheter-related bloodstream infections group (27% and 43%, respectively; P =.02). Similarly, compared with the non-CLABSI group, early CVC removal-associated microbiologic eradication was also higher in the CLABSI without mucosal barrier injury/CRBSI group (48% and 78%, respectively; P =.016). Further, the rate of complications was lower in the CLABSI without mucosal barrier injury/catheter-related bloodstream infections group than in the non-CLABSI group (0%, and 18%, respectively; P =.017). However, all-cause mortality, infection-related mortality, defervescence, and relapse were similar in both groups.
Overall, the researchers concluded that, “In cases of [Enterococcus-related bacteremia], early CVC removal within 3 days of bacteremia is associated with a favorable outcome in the CLABSI without [mucosal barrier injury/catheter-related bloodstream infections] group compared to the non-CLABSI group.”
Khalil M, Chaftari AM, Fares J, et al. The impact of early central venous catheter removal in the management of enterococcus central line-associated bloodstream infections. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC.