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Título: | Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort |
Autor: | Calò, Federica; Retamar Gentil, Pilar CSIC ORCID; Martínez Pérez-Crespo, Pedro María; Lanz-García, Joaquín CSIC; Sousa, Adrián; Goikoetxea-Aguirre, Josune; Reguera-Iglesias, J. M.; León Jiménez, Eva CSIC; Armiñanzas Castillo, Carlos; Mantecón Vallejo, María Ángeles; Rodríguez-Baño, Jesús CSIC ORCID | Fecha de publicación: | oct-2020 | Editor: | Oxford University Press | Citación: | Journal of Antimicrobial Chemotherapy 75(10): 3056-3061 (2020) | Resumen: | [Background] Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances. [Objectives]To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI. [Methods] Patients with CRBSI were selected from the PROBAC cohort, a prospective, observational, multicentre national cohort study including patients with bloodstream infections consecutively admitted to 26 Spanish hospitals in a 6 month period (October 2016–March 2017). Outcome variables were GNB aetiology and 30 day mortality. Adjusted analyses were performed by logistic regression. [Results] Six hundred and thirty-one episodes of CRBSI were included in the study. Risk factors independently related to GNB aetiology were central venous catheter (CVC) [OR 1.60 (95% CI: 1.05–2.44), P = 0.028], sepsis/septic shock [OR: 1.76 (95% CI: 1.11–2.80), P = 0.016], antibiotic therapy in the previous 30 days [OR: 1.56 (95% CI: 1.02–2.36), P = 0.037], neutropenia <500/μL [OR: 2.01 (95% CI: 1.04–3.87), P = 0.037] and peripheral vascular disease [OR: 2.04 (95% CI: 1.13–3.68), P = 0.018]. GNB were not associated with increased mortality in adjusted analysis, while removal of catheter [OR: 0.24 (95% CI: 0.09–0.61), P = 0.002] and adequate empirical treatment [OR: 0.37 (95% CI: 0.18–0.77), P = 0.008] were strong protective factors. [Conclusions] Our study reinforces the recommendation that empirical coverage should cover GNB in patients presenting with sepsis/septic shock and in neutropenic patients. Catheter removal and adequate empirical treatment were both protective factors against mortality in patients with CRBSI. |
Descripción: | PROBAC REIPI/GEIH-SEIMC/SAEI. | Versión del editor: | http://doi.org/10.1093/jac/dkaa262 | URI: | http://hdl.handle.net/10261/236694 | DOI: | 10.1093/jac/dkaa262 | Identificadores: | doi: 10.1093/jac/dkaa262 issn: 0305-7453 e-issn: 1460-2091 |
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