557. Catheter Removal versus Retention in the Management of Catheter-Associated Enterococcal Bloodstream Infections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Enterococci are an important cause of central venous catheter (CVC)-associated bloodstream infections (CA-BSI). It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI. Our objective was to determine whether CVC retention was associated with worse patient outcomes.
Methods: We retrospectively reviewed medical records of adult inpatients diagnosed with enterococcal CA-BSI at a tertiary care hospital during 2006. Demographic, clinical, and outcome data were collected. A CVC was considered retained if present for ≥96 hours after the first (+) blood culture.
Results: 106 patients (pts) had an enterococcal CA-BSI. The median age was 60 years (range 21-94). 18 (17%) pts were neutropenic. 51 (48%) infections were caused by E. faecalis [13 (26%) vancomycin-resistant], 50 (47%) by E. faecium [46 (92%) vancomycin-resistant], and 5 (5%) by other Enterococcus spp. 43 (41%) were polymicrobial BSI. Pts were treated with linezolid (48; 46%), vancomycin (38; 36%), daptomycin (9; 9%), ampicillin (2; 2%), or quinupristin/dalfopristin (2; 2%); 7 (7%) pts did not receive enterococcal treatment. 26 (25%) received adjunctive gentamicin treatment.
The CVC was retained for ≥96 hours in 51 (48%) pts. Pts with retained CVCs were similar to pts whose CVC was removed based on the Charlson comorbidity score (mean 3.1 vs. 3.1; p=1.0) and receipt of effective antibiotic treatment for ≥4 days [40 (78%) vs. 42 (76%); p=0.8]. Pts with retained CVCs were more likely to receive adjunctive gentamicin treatment [17 (33%) vs. 9 (16%); p=0.04]. Pts with retained CVCs had similar rates of BSI recurrence [8 (16%) vs. 4 (7%); p=0.4], post-BSI length of hospital stay [median 11.2 (range 4-87) vs. 8.6 days (range 1-73); p=0.2], and mortality [10 (20%) vs. 11 (20%); p=1.0] compared to pts whose CVC was removed.
Conclusions: To our knowledge, this is the largest series of enterococcal CA-BSI to date. There was no difference in outcomes between pts with or without CVC removal. Synergistic aminoglycosides were more frequently used when CVCs were retained. Additional multicenter studies are necessary to determine the optimal management of CA-BSI.
Joshua A Doherty, BS, Victoria Fraser, MD2, Jonas Marschall, MD3, Marilyn Piccirillo, NA2, David K. Warren, MD, MPH3 and  J. Marschall, None..
M. L. Piccirillo, None. 
V. J. Fraser,
Johnson & Johnson Role(s): Speaker's Bureau, Received: Speaker Honorarium.
Hawaii Chitopure Role(s): Consultant, Received: Consulting Fee.
Ancora Role(s): Consultant, Received: Consulting Fee.
J. Doherty, None. 
D. K. Warren,
3M Healthcare Role(s): Consultant, Received: Consulting Fee.
Cardinal Health Role(s): Consultant, Received: Consulting Fee.
Sage Products Role(s): Research Relationship, Received: Research Support.
Cubist Pharmaceuticals Role(s): Research Relationship, Received: Research Support.
BioMerieux Role(s): Research Relationship, Received: Research Support.
Chitopure Role(s): Consultant, Received: Consulting Fee., (1)Washington University School of Medicine, St. Louis, MO, (2)Washington University School of Medicine, Saint Louis, MO