Evaluation of central line salvage for mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) management practices in patients with hematologic malignancies

Figures & data

Figure 1. Survey results on diagnostic and therapeutic practice variations for mucosal barrier injury blood stream infections among cancer centers.

Table 1. Baseline characteristics of patients at the time of mucosal barrier injury blood stream infection.

	Catheter removal n = 90		Catheter salvage n = 25		P-value
	N	%	N	%
Age, median (range)	59.5 (23–83)	–	63(22–74)	–	0.58
Age at bacteremia, median (range)	58.5 (22–81)	–	62 (21–73)	–	0.72
Gender
Men	52	57.6	18	72	0.25
Women	38	42.4	7	28
Malignancy type
Acute myeloid leukemia	53	58.9	13	52	0.09
Myelodysplastic syndrome (MDS/MPN/CML/CMML)	17	18.9	4	16
Acute lymphocytic leukemia	7	7.8	7	28
Non-Hodgkin’s lymphoma	8	8.9	0	0
Hodgkin’s lymphoma	2	2.2	1	4
Multiple Myeloma	3	3.3	0	0
Neutropenia < 500 cell/microL	87	96.7	24	96	0.99
Reason for admission
Chemotherapy	50	55.6	10	40	0.21
HCT^a and/or cellular therapy	26	28.9	12	48
Others	14	15.6	3	12
Type of bacteremia
Gram negative	54	60	14	56	0.84
Gram positive	28	31.1	8	32
Polymicrobial	8	8.9	3	12
Pitt bacteremia score, median (range)	1	0–4	0	0–2	0.001
Catheter type
Tunneled	54	60	16	64	0.39
Peripherally inserted central catheter	31	34.4	6	24
Port	5	5.6	3	12
Source of positive blood culture
Catheter and periphery	60	66.7	9	36	<0.001
Catheter only	22	24.4	9	36
Peripheral only	8	8.9	7	28
Days to blood culture clearance, median (range)	1	0–6	1	0–3	0.34

CMML: Chronic myelomonocytic leukemia; CML: Chronic myeloid leukemia; MDS: Myelodysplastic syndromes; MPN: Myeloproliferative neoplasms.

^aHCT: Hematopoietic stem cell transplantation.

Figure 2. Cumulative incidence of mucosal barrier injury blood stream infection among allogeneic stem cell recipients (n = 38).

Table 2. Pathogens Causing Mucosal Barrier Injury Blood Stream Infection.

Types of bacteria	Catheter Removal	Catheter Salvage
Gram Negative	n = 69 (%)	n = 17 (%)
Escherichia coli	25 (37)	7 (41)
Klebsiella  spp.	22 (32)	5 (29)
Enterobacter spp.	13 (19)	2 (11)
Citrobacter spp.	4 (5)	2 (11)
Serratia Marcescens	3 (4)	0 (0)
Proteus mirabilis	0 (0)	1 (6)
Capnocytophaga	1 (1)	0 (0)
Leptotrichia	1 (1)	0 (0)
Gram Positive	n = 51	n = 17
Alpha-hemolytic Streptococcus	20 (44)	5 (33)
Enterococcus spp	10^a (22)	2^b (13)
Fusebacterium	7 (15)	4 (27)
Streptococcus gallolyticus	2 (4)	0 (0)
Clostridium	4 (8)	2 (13)
Bifidobacterium	3 (6)	1 (6)
Granulicatella Adiacens	2 (4)	1 (6)
Rothia	1 (2)	0 (0)
Others	3^c (6)	2^d (13)
Total	N = 120	N = 34

^aE faecium (Vancomycin resistant), 4 E gallinarum, 1 E Hira.

^bPathogens are 1 E Hira, 1 E faecium (Vancomycin susceptible).

^cPathogens are 1 Finegoldia, 2 Gemella.

^dPathogens are Leuconstoc lactis and Rumminocus.

Figure 3. Overall survival among patients who underwent catheter removal and salvage: (a) all cohort (n = 115). (b) patients admitted for allogeneic hematopoietic stem cell transplant (n = 38).

Table 3. Outcomes of patients with mucosal barrier injury blood stream infection based on catheter management.

Clinical Outcomes	Catheter Removal n = 90		Catheter Salvage n = 25		P-value
	N	%	N	%
Microbiological clearance within 72 h	88^a	97.8	25	100	0.99
Defervescence within 72 h of antibiotic initiation	77	85.6	24	96	0.30
Hospital Length of stay, days, median (range)	30	3–107	33	13–112	0.74
Intensive care unit Transfer	10^b	11.1	0	0	0.12
All-cause In-hospital mortality	5	5.5	0	0	0.58
All-cause mortality within 90 days	17	18.9	6	24	0.58
Recurrent bacteremia within 90 days	2^c	2.2	0	0	0.99
Infection related mortality within 90 days	1	1.1	1	4	0.39

^aThe two patients with delayed microbiological clearance; one cleared on day 4 (catheter removed on Day 2) and the other one cleared on day 6 (catheter removed on day 5).

^bAll ten patients had catheter removed, median days 1 (0–5). All but one had their bacteremia resolved by 72 h (one patient on day 6). None required pressor.

^cEvent occurred after 79 and 43 days.