Impact of Central Venous Catheter Removal on the Recurrence of Catheter-Related Coagulase-Negative Staphylococcal Bacteremia

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Abstract
Objective: To determine the impact of catheter management on the acute and long-term outcome of catheter-related coagulase-negative staphylococcal bacteremia. Design: Retrospective surveillance of catheter-related sepsis using quantitative blood and catheter cultures. Setting: University-affiliated tertiary cancer center. Patients and Methods: Seventy patients with catheter-related coagulase-negative staphylococcal bacteremia were studied by retrospective chart review. The clinical characteristics of the patients and the management of the bacteremias were determined. The impact of immunosuppressive risk factors, antibiotic therapy, and catheter management on the recurrence of the bacteremia was investigated. Results: Acute sepsis-related morbidity and mortality were not related to catheter management. However, during a 12-week followup period, the bacteremia recurred in 20% of the patients whose catheters remained in place, compared with only 3% of those whose catheters were removed (p>.05). By multivariate analysis, patients whose catheters remained in place were 2.9 times more likely to experience a recurrence than those whose catheters were removed (odds ratio= 2.9, 95% confidence interval= 1.2-8.8, p=.03). All other potential risk factors were equally distributed between patients, with and without a recurrence. Conclusions: Although patients with catheter-related coagulase-negative staphylococcal bacteremia could be treated successfully while the catheter remains in place with the majority remaining free of recurrence, catheter retention results in a significantly higher risk for the recurrence of the bacteremia.