1353. Use of Antimicrobial Central Venous Catheters for Exchange Over Guidewire in Staphylococcus aureus Central Line Associated Bloodstream Infection
Session: Poster Abstract Session: Clinical Trials
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Central venous catheters (CVC) removal and reinsertion of a new CVC in the setting of central line associated bloodstream infections (CLABSI) is not always possible in cancer patients. We have previously demonstrated that exchanging CVCs over guidewire for minocycline-rifampin coated CVCs (MR-CVC) improve the outcome of CLABSI for different types of pathogens. The purpose of this study was to evaluate the outcome of patients with Staphylococcus aureus CLABSI (SA-CLABSI) who had their CVCs exchanged over guidewire with MR-CVCs.

Methods: We evaluated the outcome of patients who had their CVC exchanged over guidewire for MR-CVC within 7 days of SA-CLABSI at The University of Texas MD Anderson Cancer Center between January 2005 and December 2011. Each case was matched with 2 control patients who had SA-CLABSI and had their CVC removed within 7 days and 2 control patients who had their CVC retained beyond 7 days. Patients were matched based on cancer type (hematological vs. solid tumor), neutropenia status, and organism (MRSA vs. MSSA).

Results: We identified 12 patients with SA-CLABSI who had their CVC exchanged over guidewire with MR-CVC within 7 days of bacteremia. These patients were compared to 24 patients who had SA-CLABSI and had their CVC removed and 24 other patients who had their CVC retained. Patients who had their CVC exchanged over guidewire with MR-CVC or had their CVC removed within 7 days tended to have a higher rate of clinical response with fever defervescence within 3 days compared to patients whose CVC was retained beyond 7 days (75% and 73% vs. 31% respectively; P=0.052. The rate of resolution of bacteremia, relapse, deep seated infections, death and attributable mortality were similar in the 3 groups (p= 0.41, 0.41, 0.82, 0.1 and 0.12 respectively).

Conclusion: In the setting of SA-CLABSI, exchanging the CVC over guidewire with MR-CVC or removing the CVC within 7 days may be associated with a higher  rate of clinical response within 3 days compared to those whose CVC was retained. A further prospective randomized clinical trial is warranted.

Aline El Zakhem, MD1,2, Anne-Marie Chaftari, MD1, Ray Hachem, MD3, Ying Jiang, MS4 and Issam Raad, MD4, (1)Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)University of Texas M.D. Anderson Cancer Center, Houston, TX, (4)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

A. El Zakhem, None

A. M. Chaftari, None

R. Hachem, None

Y. Jiang, None

I. Raad, American Medical Systems: , Licensing agreement or royalty
Cook: Speaker's Bureau, Grant recipient and Licensing agreement or royalty
ECP: ,
Great Lakes Pharmaceuticals: ,
Inventive Protocol, Inc.: ,
Medline: , Licensing agreement or royalty
TyRx: , Licensing agreement or royalty

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