Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort
Authors: Calò Federica , Retamar Pilar , Martínez Pérez-Crespo Pedro María , Lanz-García Joaquín , Sousa Adrian , Goikoetxea Josune , Reguera-Iglesias José María , León Eva , Armiñanzas Carlos , Mantecón Maria Angeles , Rodríguez-Baño Jesús , López-Cortés Luis Eduardo ,   the PROBAC REIPI/GEIH-SEIMC/SAEI, Temprano Marta Arias , Suárez Jonathan Fernández , Boix Lucía , Calvo Juan Manuel Sánchez , Cuquet-Pedragosa Jordi , Barcenilla-Gaite Fernando , Kindelán Clara Natera , Galán Fátima , del Arco Jiménez Alfonso , Bahamonde Alberto , Smithson Alejandro , Vinuesa David , Lázaro Isabel Gea , Bertos Armando Reyes , Camacho Inés Pérez , Sánchez-Porto Antonio , García Marcos Guzmán , Carral Berta Becerril , de Lucas Esperanza Merino , Calvo J , Fariñas M C , Temprano Marta Arias , Suárez Jonathan Fernández , Boix Lucía , Calvo Juan Manuel Sánchez , Cuquet-Pedragosa Jordi , Barcenilla-Gaite Fernando , Kindelán Clara Natera , Galán Fátima , del Arco Jiménez Alfonso , Bahamonde Alberto , Smithson Alejandro , Vinuesa David , Lázaro Isabel Gea , Bertos Armando Reyes , Camacho Inés Pérez , Sánchez-Porto Antonio , García Marcos Guzmán , Carral Berta Becerril , de Lucas Esperanza Merino , Calvo J , Fariñas M C 
Published: July 2020

Abstract

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 6 month period (October 2016–March 2017). Outcome variables were GNB aetiology and 30 day 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 30 days [OR: 1.56 (95% CI: 1.02–2.36), P = 0.037], neutropenia &lt;500/μL [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.