Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Carregando...
Imagem de Miniatura
Citações na Scopus
15
Tipo de produção
article
Data de publicação
2018
Título da Revista
ISSN da Revista
Título do Volume
Editora
AMER SOC MICROBIOLOGY
Citação
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, v.62, n.9, article ID e00569-18, 9p, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus. Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.
Palavras-chave
cancer, MDR bacteria, mortality, Gram-negative bacteria, hematological malignancies, implantable catheter, lock therapy, palliative care
Referências
  1. Akahane A, 2012, UPSALA J MED SCI, V117, P300, DOI 10.3109/03009734.2012.664178
  2. Akbari F, 2015, PATHOGENS, V4, P457, DOI 10.3390/pathogens4030457
  3. Beckers MMJ, 2010, THROMB RES, V125, P318, DOI 10.1016/j.thromres.2009.06.008
  4. Bodro M, 2014, SUPPORT CARE CANCER, V22, P603, DOI 10.1007/s00520-013-2012-3
  5. Chang YF, 2013, PALLIATIVE MED, V27, P185, DOI 10.1177/0269216311428777
  6. Chen IC, 2013, ANN ONCOL, V24, P463, DOI 10.1093/annonc/mds468
  7. Dias MBS, 2008, INFECT CONT HOSP EP, V29, P125, DOI 10.1086/526440
  8. Fernandez-Hidalgo N, 2006, J ANTIMICROB CHEMOTH, V57, P1172, DOI 10.1093/jac/dk1103
  9. Foresti S, 2015, ANTIMICROB AGENTS CH, V59, P7919, DOI 10.1128/AAC.01855-15
  10. Fortun J, 2006, J ANTIMICROB CHEMOTH, V58, P816, DOI 10.1093/jac/dkl318
  11. Freire MP, 2016, CLIN MICROBIOL INFEC, V22, P352, DOI 10.1016/j.cmi.2015.12.010
  12. Funalleras G, 2011, CLIN INFECT DIS, V53, pE129, DOI 10.1093/cid/cir551
  13. Hsu JF, 2015, WORLD J SURG ONCOL, V13, DOI 10.1186/s12957-015-0707-2
  14. Justo JA, 2014, INFECT DRUG RESIST, V7, P343, DOI 10.2147/IDR.S51388
  15. Lebeaux D, 2014, LANCET INFECT DIS, V14, P146, DOI 10.1016/S1473-3099(13)70266-4
  16. Lebeaux D, 2012, MEDICINE, V91, P309, DOI 10.1097/MD.0b013e318275ffe1
  17. Mermel LA, 2009, CLIN INFECT DIS, V49, P1, DOI 10.1086/599376
  18. Moreau M, 2009, ANN ONCOL, V20, P513, DOI 10.1093/annonc/mdn655
  19. Piersigilli F, 2014, PEDIATR INFECT DIS J, V33, P419, DOI 10.1097/INF.0000000000000116
  20. Raad I, 2016, ANTIMICROB AGENTS CH, V60, P3426, DOI 10.1128/AAC.02565-15
  21. Raad I, 2014, CLIN INFECT DIS, V59, pS340, DOI 10.1093/cid/ciu670
  22. Rijnders BJ, 2005, J ANTIMICROB CHEMOTH, V55, P90, DOI 10.1093/jac/dkh488
  23. Soman Rajeev, 2016, J Assoc Physicians India, V64, P32
  24. Toure A, 2012, AM J INFECT CONTROL, V40, P935, DOI 10.1016/j.ajic.2012.01.024
  25. Tsai HC, 2015, J MICROBIOL IMMUNOL, V48, P639, DOI 10.1016/j.jmii.2014.07.008
  26. Turkoglu M, 2011, J CRIT CARE, V26, P460, DOI 10.1016/j.jcrc.2011.04.007
  27. Vidal M, 2016, MED MALADIES INFECT, V46, P32, DOI 10.1016/j.medmal.2015.12.006
  28. Xu CL, 2016, CANCER CHEMOTH PHARM, V78, P119, DOI 10.1007/s00280-016-3057-z
  29. Yoshida J, 2011, AM J INFECT CONTROL, V39, pE39, DOI 10.1016/j.ajic.2010.11.013
  30. Zhong L, 2012, J INFECTION, V64, P299, DOI 10.1016/j.jinf.2011.12.005