Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Maristela P. Freire; Ligia C. Pierrotti; Antonio E. Zerati; Luciana Benites; Joaquim Mauricio da Motta-Leal Filho; Karim Y. Ibrahim; Pedro H. Araujo; Edson Abdala

doi:10.1128/AAC.00569-18

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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Journal article

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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Maristela P. Freire, Ligia C. Pierrotti, Antonio E. Zerati, Luciana Benites, Joaquim Mauricio da Motta-Leal Filho, Karim Y. Ibrahim, Pedro H. Araujo and Edson Abdala

Antimicrobial agents and chemotherapy, Vol.62(9), 00569

09/01/2018

DOI: 10.1128/AAC.00569-18

PMID: 29987150

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Abstract

The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus. Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.

Life Sciences & Biomedicine

Microbiology

Pharmacology & Pharmacy

Science & Technology

Details

Title: Subtitle: Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria
Creators: Maristela P. Freire - Instituto do Câncer do Estado de São Paulo
Ligia C. Pierrotti - Universidade de São Paulo
Antonio E. Zerati - Instituto do Câncer do Estado de São Paulo
Luciana Benites - Universidade de São Paulo
Joaquim Mauricio da Motta-Leal Filho - Universidade de São Paulo
Karim Y. Ibrahim - Universidade de São Paulo
Pedro H. Araujo - Universidade de São Paulo
Edson Abdala - Universidade de São Paulo
Resource Type: Journal article
Publication Details: Antimicrobial agents and chemotherapy, Vol.62(9), 00569
DOI: 10.1128/AAC.00569-18
PMID: 29987150
NLM abbreviation: Antimicrob Agents Chemother
ISSN: 0066-4804
eISSN: 1098-6596
Publisher: Amer Soc Microbiology
Number of pages: 9
Language: English
Date published: 09/01/2018
Academic Unit: Radiology
Record Identifier: 9985180929002771

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