Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort
Por:
Calo, F, Retamar, P, Perez-Crespo, P, Lanz-Garcia, J, Sousa, A, Goikoetxea, J, Reguera-Iglesias, J, Leon, E, Arminanzas, C, Mantecon, M, Rodriguez-Bano, J, Lopez-Cortes, L and PROBAC REIPI GEIH-SEIMC SAEI
Publicada:
1 oct 2020
Resumen:
Background: Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances.
Objectives: To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI.
Methods: Patients with CRBSI were selected from the PROBAC cohort, a prospective, observational, multicentre national cohort study including patients with bloodstream infections consecutively admitted to 26 Spanish hospitals in a 6month period (October 2016-March 2017). Outcome variables were GNB aetiology and 30day mortality. Adjusted analyses were performed by logistic regression.
Results: Six hundred and thirty-one episodes of CRBSI were included in the study. Risk factors independently related to GNB aetiology were central venous catheter (CVC) [OR 1.60 (95% CI: 1.05-2.44), P=0.028], sepsis/septic shock [OR: 1.76 (95% CI: 1.11-2.80), P=0.016], antibiotic therapy in the previous 30days [OR: 1.56 (95% CI: 1.02-2.36), P=0.037], neutropenia <500/mu L [OR: 2.01 (95% CI: 1.04-3.87), P=0.037] and peripheral vascular disease [OR: 2.04 (95% CI: 1.13-3.68), P=0.018]. GNB were not associated with increased mortality in adjusted analysis, while removal of catheter [OR: 0.24 (95% CI: 0.09-0.61), P=0.002] and adequate empirical treatment [OR: 0.37 (95% CI: 0.18-0.77), P=0.008] were strong protective factors.
Conclusions: Our study reinforces the recommendation that empirical coverage should cover GNB in patients presenting with sepsis/septic shock and in neutropenic patients. Catheter removal and adequate empirical treatment were both protective factors against mortality in patients with CRBSI.
Filiaciones:
Calo, F:
Univ Campania Luigi Vanvitelli, Dept Mental Hlth & Publ Med, Infect Dis Unit, Naples, Italy
:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Perez-Crespo, P:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Lanz-Garcia, J:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Sousa, A:
Complexo Hosp Univ Vigo, Internal Med Dept, Infect Dis Unit, Vigo, Spain
Complexo Hosp Univ Vigo, Inst Invest Biorned Galicia Sur, Vigo, Spain
Goikoetxea, J:
Univ Basque Country, IXA NLP Grp, Fac Informat, Manuel Lardizabal 1, Donostia San Sebastian 20018, Basque Country, Spain
Reguera-Iglesias, J:
Soc Andaluza Enfermedades Infecciosas, Grp Estudio Infecc Cardiovasc, Seville, Spain
Hosp Reg Univ Malaga, Serv Enfermedades Infecciosas, Malaga, Spain
:
Hosp Univ Virgen de Valme, Unidad Gest Clin Enfermedades Infecciosas, Seville, Spain
Arminanzas, C:
Univ Cantabria, Serv Enfermedades Infecciosas, HU Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
Mantecon, M:
Hosp Univ Burgos, Unidad Gest Clin Enfermedades Infecciosas, Burgos, Spain
Rodriguez-Bano, J:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Lopez-Cortes, L:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
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