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2099. Catheter-related Staphylococcus aureus Bacteremia and Septic Thrombosis: The Role of Anticoagulation and Duration of Intravenous Antibiotic Therapy

Abstract Background Catheter-related septic thrombosis is suspected in patients with persistent Central Line-associated Blood Stream Infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. There are limited data outlining the characteristics of the disease and the adequate duration of antimicrobials. In addition, the role of anticoagulation in the management of septic thrombosis remains unclear. We herein studied the clinical characteristics of staphylococcus aureus catheter-related septic thrombosis as well as the appropriate management and duration of treatment. Methods We conducted this retrospective study where we included patients with CLABSI due to Staphylococcus aureus who had a concomitant radiographic evidence of thrombosis at the level of catheter placement between the years 2005 and 2017. We collected data pertaining to patients’ medical history, clinical presentation, management, treatment and outcome within 3 months of bacteremia onset. Failure was defined as persistence of signs and symptoms at 72 hours, persistence bacteremia at 48–96 hours, relapse, complications or overall mortality. Results A total of 128 patients were included. The median age was 55 years. Total relapse/recurrence rate was 8% and all-cause mortality within 3 months was 16%. We found no significant difference in overall outcome between patients who had deep vs. superficial thrombosis. Patients with superficial thrombosis were found to have higher rate of pulmonary complications (25% vs. 6%; P = 0.01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs. 5% P = 0.001). A multivariate logistic regression analysis identified two independent predictors of treatment failure: presence in the ICU at any point during their illness (odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.08–6.99, P = 0.034) and not receiving anticoagulation (OR = 0.24, 95% CI = 0.11–0.54, P < 0.001). Conclusion Intravenous antimicrobial therapy for 28 days or longer carries a survival advantage over shorter duration of therapy and anticoagulation as an adjunctive treatment is an independent predictor of successful antimicrobial therapy. Disclosures I. Raad, The University of Texas MD Anderson Cancer Center: Shareholder, Licensing agreement or royalty. The Unversity of Texas MD Anderson Cancer Center: Shareholder, Dr. Raad is a co-inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology which is owned by the University of Texas MD Anderson Cancer Center (UTMDACC) and has been licensed to Novel Anti-Infective Technologies LLC, in which UTMDACC and Licensing agreement or royalty.

Background. CLABSI surveillance at our institution indicated that a significant proportion of CLABSI had a positive blood culture drawn from central line (CL-BC) with corresponding negative BC done by venipuncture (VP-BC), suggesting possible CL contamination. The contribution of minimizing CL-BC on CLABSI rates remains unknown. This study evaluates the impact on CLABSI rates of reducing CL-BC in addition to standard CLABSI reduction strategies in adult intensive care units (ICUs).
Methods. The study was done from January 1, 2015 to August 31, 2017 in adult ICUs at a hospital with 164 ICU beds, in urban Detroit. Education initiatives to minimize CL-BC were implemented in the ICU. Internal metrics VP-BC ratio (No. VP-BC/ total BC in patients with CL) and CL-BC ratio (No. CL-BC/total BC in patients with CL) were used to monitor effectiveness. Compliance audits of CL maintenance were done, i.e., CL dressing intact, proper use of chlorhexidine dressing, site without redness or drainage. Monthly unit-specific CLABSI rates, CL utilization ratios (CL-UR), and VP-BC and CL-BC ratios were provided as feedback to the ICUs. CLABSI rates and number of contaminated BC were monitored. Trends of the various metrics were analyzed using Kendall Tau's correlation for continuous variables. The relationship between CLABSI rate, VP-BC ratios and CL-UR were examined using Spearman's correlation coefficient. Statistical significance was set at P < 0.05.
Results. During the study period in the ICU there were 148,762 patient-days and 82,153 CL days. Trends over time of the metrics are shown (figure). There was significant improvement noted in CLABSI rates, CL-UR and VP-BC rates (Table 1). There was a significant correlation between the CLABSI rates with VP-BC −0.395 (P value = 0.025) and a not significant correlation with CL-UR 0.278 (P value = 0.123). The number of contaminated blood cultures were 29, 3, and 0 in 2015, 2016 and 2017, respectively.
Conclusion. Minimizing BC obtained from CL can significantly contribute to reduction in CLABSI rates when used in combination with standard best care practices for CL insertion and maintenance. Methods. We conducted this retrospective study where we included patients with CLABSI due to Staphylococcus aureus who had a concomitant radiographic evidence of thrombosis at the level of catheter placement between the years 2005 and 2017. We collected data pertaining to patients' medical history, clinical presentation, management, treatment and outcome within 3 months of bacteremia onset. Failure was defined as persistence of signs and symptoms at 72 hours, persistence bacteremia at 48-96 hours, relapse, complications or overall mortality.
Results. A total of 128 patients were included. The median age was 55 years. Total relapse/recurrence rate was 8% and all-cause mortality within 3 months was 16%. We found no significant difference in overall outcome between patients who had deep vs. superficial thrombosis. Patients with superficial thrombosis were found to have higher rate of pulmonary complications (25% vs. 6%; P = 0.01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs. 5% P = 0.001). A multivariate logistic regression analysis identified two independent predictors of treatment failure: presence in the ICU at any point during their illness (odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.08-6.99, P = 0.034) and not receiving anticoagulation (OR = 0.24, 95% CI = 0.11-0.54, P < 0.001).
Conclusion. Intravenous antimicrobial therapy for 28 days or longer carries a survival advantage over shorter duration of therapy and anticoagulation as an adjunctive treatment is an independent predictor of successful antimicrobial therapy.
Disclosures. I. Raad, The University of Texas MD Anderson Cancer Center: Shareholder, Licensing agreement or royalty. The Unversity of Texas MD Anderson Cancer Center: Shareholder, Dr. Raad is a co-inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology which is owned by the University of Texas MD Anderson Cancer Center (UTMDACC) and has been licensed to Novel Anti-Infective Technologies LLC, in which UTMDACC and Licensing agreement or royalty.