Empiric therapy for intravenous central line infections and nosocomially-acquired acute bacterial endocarditis

Infective Endocarditis Following Post-COVID Organizing Pneumonia Complicated by Multiple Splenic Abscesses and Glomerular Nephritis

The association of glomerular nephritis and infective endocarditis with liver abscesses is a clinically complex entity that often makes the diagnosis challenging. Here, we report a case of a 50-year-old woman who presented with a febrile illness of two weeks' duration along with myalgia and malaise of four days' duration. She had a background history of well-controlled type 2 diabetes mellitus for five years with a past history of ischemic heart disease diagnosed five years ago. At the time of presentation, she was on long-term steroids for post-coronavirus disease (COVID) organizing pneumonia diagnosed three months back. With serial investigations, she was found to have subacute bacterial endocarditis with multiple liver and splenic abscesses. She was managed with antibiotics as per local protocols after which she made a successful recovery of her clinical status. The uniqueness of this case is the development of rare complications of subacute bacterial endocarditis in the background of immunosuppression.

Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort

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.

Central line-associated bloodstream infections: prevention and management

Approximately 80,000 central venous line-associated bloodstream infections (CLA-BSI) occur in the United States each year. CLA-BSI is most commonly caused by coagulase-negative staphylococci, Staphylococcus aureus, Candida spp, and aerobic gram-negative bacilli. These organisms commonly gain entrance in into the bloodstream via the catheter-skin interface (insertion site) or via the catheter hub. Use of strict aseptic technique for insertion is the key method for the prevention of CLA-BSI. Various methods can be used to reduce unacceptably high rates of CLA-BSI, including use of an antiseptic- or antibiotic-impregnated catheter, daily chlorhexidine baths/washes, and placement of a chlorhexidine-impregnated sponge over the insertion site.

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America

These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.