Lee YM, et al. - In this study, the impact of delayed central venous catheter (CVC) removal on clinical outcomes was assessed in patients with gram-negative catheter-related bloodstream infections (CRBSI). As per findings, CVCs should be removed early to improve clinical outcomes in these patients. This should be performed especially where there is high prevalence of multidrug-resistant (MDR) isolates.

Methods

• Patients with gram-negative bacteremia and CVC placement were retrospectively included from two tertiary care hospitals from January 2007 to December 2016.
• They classified the cases with CVC removal > 3 days after onset of bacteremia or without CVC removal as having delayed CVC removal.

Results

• This study included a total of 112 patients; 78 indicated CRBSI (43 definite and 35 probable), and 34 had gram-negative bacteremia from another source (non-CRBSI).
• In patients with CRBSI, the Enterobacteriaceae were less frequent pathogens than in those with non-CRBSI (11.5% vs. 41.3%; P <0.001).
• In patients with gram-negative CRBSI, an association of delayed CVC removal was observed with increased 30-day mortality (40.5% vs. 11.8%; P=0.01); this was not seen in patients with non-CRBSI (25.0% vs. 14.3%; P >0.99).
• Thirty-day mortality was seen associated with delayed CVC removal [OR = 6.8], MDR gram-negative bacteremia [OR = 6.3], and chronic renal failure [OR = 11.1] in patients with CRBSI.
• The MDR group showed the protective effect of early CVC removal on mortality (48.3% vs. 18.2%; P = 0.03), but this was not evident in the non-MDR group (11.1% vs. 0%; P=0.43).