Central line-associated bloodstream infections caused by Staphylococcus aureus in cancer patients: Clinical outcome and management

Background. There are limited data regarding clinical presentation and management of Staphylococcus aureus central lineassociated bloodstream infection (CLABSI) in immunocompromised cancer patients. Methods. In this review, we evaluated 299 patients with 304 episodes of S. aureus -CLABSI between 2005 and 2011. Findings. By multivariate analysis, the major predictors of complicated S. aureus-CLABSI were septic shock, catheter site inflammation, presence of peripherally inserted central catheter, anti-cancer chemotherapy within 10 days, and persistent bacteremia beyond 72 hours (P <= 0.02). A total of 67% of the cases were defined as complicated. In the subset of patients who were uncomplicated on presentation, patients receiving antimicrobials >= 14 days had similar rates of relapse, attributable mortality, and development of complications compared to those receiving shorter-course therapy. By competing risk analysis, removal of the catheter within 3 days of the onset of bacteremia was associated with a lower relapse rate at 90 days (P = 0.024). Interpretation. The majority of S. aureus-CLABSI in cancer patients are complicated and require prolonged course of antimicrobial treatment. Early removal of the catheter within the first 3 days is associated with better course. In patients with prompt removal of the catheter and no evidence of a complicated course, treatment beyond 2 weeks may not be necessary.