JAC Advance Access published online on September 20, 2002
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkf182
© 2002 by The British Society for Antimicrobial Chemotherapy
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Original Paper
1 The
General Infirmary at Leeds; University
of Leeds, Leeds LS1 3EX, UK
* Corresponding author. E-mail: micjs{at}leeds.ac.uk.
Received 17 May 2002
; revised 11 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
Enterococcal intravascular catheter-related bloodstream
infection: management and outcome of 61 consecutive cases
2 University
of Leeds, Leeds LS1 3EX, UK
3 The
General Infirmary at Leeds
4 The
General Infirmary at Leeds; University
of Leeds, Leeds LS1 3EX, UK
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