Italy: Study on CLABSIs Treatment

A new study found that early removal of the central line and a 7-day course of antibiotics was an effective and safe treatment strategy in uncomplicated enterococcal central line-associated bloodstream infections (CLABSIs). The article was published in the European Journal of Clinical Microbiology & Infectious Diseases.

Central lines, also known as CVCs (Central venous catheters), are commonly used to provide fluids, medications, or blood, and can also be utilized for quick medical tests in patients. Central line insertion is a common and often necessary procedure for the care of critically ill patients. A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line and is a highly prevalent problem in ICU patients.

Enterococcus species are the third most common organisms causing central line-associated bloodstream infections (CLABSIs). Removal of the catheter and systemic antibiotic for 7-14 days is the treatment guideline set by the Infectious Diseases Society of America for uncomplicated central line-associated bloodstream infections (CLABSIs). However, the management strategy is not well defined for Enterococcus-related bacteremia, due to a lack of data.

Rosselli Del Turco, Policlinico Sant'Orsola-Malpighi, IRCCS Sant'Orsola, Italy, and colleagues conducted a study to assess the appropriate treatment duration for enterococcal central line-associated bloodstream infections (CLABSIs).

For the study, researchers enrolled 113 patients with monomicrobial enterococcal CLABSI, of whom 59% were male, the median age was 64 (SD ± 15) and the median Charlson's index score was 5 (IQR 3–8). Enterococcus faecalis and Enterococcus faecium were found in 51% and 44% of cases, respectively. Those with infective endocarditis and non-survivors at least 7 days from index blood culture (BC) were excluded. The primary endpoint was 30-day mortality.

Key Observations

• The median treatment duration was 11 days, and 32% of patients (n = 36) received ≤ 7 days.
• Characteristics of patients receiving more or less than 7 days of treatment were similar.
• The central line was removed in 82% (n = 93) of cases within a median of 3 days.
• At both uni- and multivariate analysis, duration of antibiotic treatment > 7 days was not associated with 30-day mortality [HR- 0.41] even after adjustment with propensity score [HR-0.47].

The authors conclude that a 7-day course of antibiotics was safe and was not associated with 30-day mortality in non-complicated enterococcal central line-associated bloodstream infections (CLABSIs).

Reference

Rosselli Del Turco E, Pasquini Z, Scolz K, Amedeo A, Beci G, Giglia M, Bussini L, Carvalho-Brugger S, Gutiérrez L, Tedeschi S, Garcia M, Ambretti S, Pericàs JM, Giannella M, Viale P, Bartoletti M. Treatment duration for central line-associated infection caused by Enterococcus spp.: a retrospective evaluation of a multicenter cohort. Eur J Clin Microbiol Infect Dis. 2022 Aug 1. doi: 10.1007/s10096-022-04481-w. Epub ahead of print. PMID: 35915273.