Infections associated with central lines are caused by Enterococcus species in the third most common way. Whether and when
catheters should be removed in enterococcal CLABSI are not well defined. Our study was therefore designed to determine
how best to manage enterococcal CLABSI in cancer patients. Methods : An analysis was conducted of data collected from
542 patients with Enterococcus bacteremia. Our remaining 397 patients were divided into three groups, after we excluded
patients with a central venous catheter (CVC) without bacteremia, those with polymicrobial bacteremia, and those with central
venous catheter placement within 48 hours of onset of bacteremia. A catheter-related bloodstream infection (CRBSI) is
defined as a bloodstream infection that occurs in a catheter. The catheter-related bloodstream infection (CLABSI) is defined as
an infection that occurs in either one of the two groups. The International Society of Infectious Diseases (IDSA) has
developed guidelines for diagnosing and treating intravascular catheter-related infections (CLABSI). Patients who don't meet
the CDC's definition of CLABSI are placed in Group 3 (G3). A comparison was conducted between early and late CVC
removal (* 3 days after bacterial infection onset). Comprised of absence of microbiologic recurrence, infection-related
mortality over 90 days, and infection-related complications over 90 days, these were the composite primary outcomes. A trend
towards better overall outcomes was observed among patients in G2 whose CVCs were removed within 3 days of bacteremia
onset (success rate: 88%), as opposed to those who had them removed between days 3 and 7 (success rate: 63%).
Nevertheless, the success rate for those who retained CVCs beyond 7 days was similar to that of those who removed CVCs
within?3?days (92% vs. 88%). Those who retained their catheters longer (> 7 days) reported higher success rates than those
who removed the catheters sooner (93% vs. 67%, p?=?0.003). When CVCs were retained (withdrawal > 7 days) in nonCLABSI cases (G3), the success rate was significantly higher than when they were removed early (3?days) (90% vs. 64%, p
=?0.006). Enterococcal bacteraemia is challenging to manage with a catheter. A less than 3 day CVC removal may positively
affect outcomes when it is clinically indicated for patients with enterococcal CLABSI. Based on our data, we cannot
determine whether increased outcomes are associated with earlier removal of CVCs for patients with enterococcal CLABSI
whose CVCs are clinically indicated. A lower success rate was associated with catheter retention as opposed to insertion. This
aspect of the procedure needs further study
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