Central line-associated bloodstream infections caused by Staphylococcus aureus in cancer patients: clinical outcome and management

Figures & data

Figure 1. Classification of S. aureus-CLABSI.

Table I. Patients’ characteristics and clinical presentation.

Demographics and clinical presentation	n = 304	(%)
Median age (range), years	58 (0.4–92)
Male sex	188	(62)
Malignancy
Solid	147	(48)
Hematological	157	(52)
Foreign body	27	(9)
Intravascular (pacemaker, graft)	8	(3)
Extravascular	19	(6)
Steroids	98	(32)
Diabetes mellitus	45	(15)
MRSA	144	(47)
Neutrophils < 500	69	(23)
Vancomycin
MIC < 2 μg/mL	150	(49)
MIC = 2 μg/mL	154	(51)
Catheter
PICC	141	(46)
CVC	102	(33)
Subcutaneous port	50	(16)
Others	11	(5)
Temperature (°C)
36–38	65	(21)
≤ 36	29	(10)
≥ 38	210	(69)
Sepsis
No sepsis	74	(24)
Sepsis	177	(58)
Severe sepsis	27	(9)
Septic shock	26	(9)
Catheter site infection	83	(28)

CVC = central venous catheter; MIC = minimal inhibitory concentration; MRSA = methicillin-resistant Staphylococcus aureus; PICC = peripherally inserted central catheters.

Table II. Clinical course and outcome of S. aureus-CLABSI.

Outcome	n = 304	(%)
Defervescence at 72 hours^a	146/210	(70)
Eradication of bacteremia at 72 hours^b	133/177	(75)
Relapse	28	(9)
Infective endocarditis	17	(6)
Septic thrombosis	73	(24)
Deep-tissue abscess	15	(5)
Epidural abscess	3	(1)
Meningitis	1	(0.3)
Psoas abscess	1	(0.3)
Septic arthritis	3	(1)
Osteomyelitis	5	(2)
Pulmonary septic emboli	30	(10)
Overall 3-month mortality	73	(24)
Attributable mortality	29	(10)

^aDefervescence was evaluated only in the 210 episodes with fever on presentation.

^bBacterial eradication was evaluated only in 177 episodes with documented repeat blood cultures.

Table III. Risk factors for complicated S. aureus-CLABSI course on multivariate analysis.

Risk factors	Uncomplicated course	Complicated course	Univariate analysis P value	Multivariate analysis
	n = 158	n = 146		OR	CI	P-value
Sepsis
No sepsis	43	31	0.01
Sepsis	96	81		1.01	(0.55–1.87)	0.97
Severe sepsis	13	14		1.37	(0.51–3.70)	0.53
Septic shock	6	20		4.42	(1.43–13.65)	0.01
Catheter type
PICC	62	79	0.01	1.88	(1.13–3.13)	0.02
Non-PICC	96	67
Catheter site inflammation
Yes	30	53	0.01	2.00	(1.12–3.58)	0.02
No	128	93
Chemotherapy within 10 days after the onset of bacteremia
Yes	9	21	0.02	3.12	(1.24–7.87)	0.02
No	147	125
Persistent bacteremia for > 72 h
Yes	36	53	0.01	1.95	(1.10–3.45)	0.02
No	122	93

CLABSI = central line-associated bloodstream infection; CI = confidence interval; OR = odds ratio; PICC = peripherally inserted central catheter.

Figure 2. Estimated cumulative incidence curves of relapse of S. aureus-CLABSI by competing risk analysis with death as the competing event (P = 0.024).