JAC Advance Access originally published online on September 20, 2002
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Journal of Antimicrobial Chemotherapy (2002) 50, 577-582
© 2002 The British Society for Antimicrobial Chemotherapy
Enterococcal intravascular catheter-related bloodstream infection: management and outcome of 61 consecutive cases
Department of Microbiology, 1 The General Infirmary at Leeds, 2 University of Leeds, Leeds LS1 3EX, UK
Received 17 May 2002; returned 11 July 2002; revised 12 July 2002; accepted 17 July 2002
Enterococci are an increasingly important cause of intravascular catheter-related bloodstream infection (CRBSI), but the evidence base for treating such cases is limited. Successful antimicrobial treatment of CRBSI while leaving the central venous catheter (CVC) in situ has been reported for some bacteria, such as coagulase-negative staphylococci, but the effectiveness of this approach for treating enterococcal CRBSI is unknown. We aimed to determine the effectiveness of treatment options for enterococcal CRBSI and whether CVC removal is mandatory. Treatment and outcome was determined in a 3 year cohort of patients with enterococcal CRBSI from a university teaching hospital. All episodes of enterococcal bacteraemia during the study (n = 268) were examined to identify the cohort of 61 CRBSIs. Outcomes were determined for various antimicrobial regimens with or without CVC removal. Forty-eight episodes were managed with CVC removal and 13 were managed with the CVC in situ. Forty of 48 (83%) and five of 13 (38%) episodes were cured with the CVC removed or left in situ, respectively. All five episodes cured with the CVC in situ were treated with a cell wall-acting antimicrobial plus an aminoglycoside. This antimicrobial combination was significantly more effective than either ampicillin or vancomycin monotherapy (P < 0.05), or antimicrobials to which isolates were not susceptible (P < 0.01) when the CVC remained in situ. We conclude that enterococcal CRBSI can be treated successfully without CVC removal. The combination of a cell wall-acting antimicrobial with an aminoglycoside was the most effective regimen when the CVC remained in situ in this small group of patients. Although CVC removal was associated with a high cure rate, it did not guarantee treatment success.
Keywords: Enterococcus, intravascular catheter, bloodstream infection
* Correspondence address. Department of Microbiology, Old Medical School, University of Leeds, Leeds LS2 9JT, UK. Tel: +44-113-343-5634; Fax: +44-113-343-5638; E-mail: micjs{at}leeds.ac.uk
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. A. T. Sandoe, J. Wysome, A. P. West, J. Heritage, and M. H. Wilcox Measurement of ampicillin, vancomycin, linezolid and gentamicin activity against enterococcal biofilms J. Antimicrob. Chemother., April 1, 2006; 57(4): 767 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. I. Raad, H. A. Hanna, M. Boktour, G. Chaiban, R. Y. Hachem, T. Dvorak, R. Lewis, and B. E. Murray Vancomycin-Resistant Enterococcus faecium: Catheter Colonization, esp Gene, and Decreased Susceptibility to Antibiotics in Biofilm Antimicrob. Agents Chemother., December 1, 2005; 49(12): 5046 - 5050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. P. Wiederhold, E. A. Coyle, I. I. Raad, R. A. Prince, and R. E. Lewis Antibacterial activity of linezolid and vancomycin in an in vitro pharmacodynamic model of Gram-positive catheter-related bacteraemia J. Antimicrob. Chemother., May 1, 2005; 55(5): 792 - 795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A.T. Sandoe, I. R. Witherden, J. H. Cove, J. Heritage, and M. H. Wilcox Correlation between enterococcal biofilm formation in vitro and medical-device-related infection potential in vivo J. Med. Microbiol., July 1, 2003; 52(7): 547 - 550. [Abstract] [Full Text] [PDF]
|
|