Hickman catheter salvage in neutropenic patients with Staphylococcus aureus bacteremia

Excerpt

We read with interest the paper of Fätkenheuer et al. about central venous catheter-related infections in neutropenic patients [1]. The authors noted that catheter preservation is inadvisable in patients with Staphylococcus aureus bacteremia (SAB) because of low catheter salvage rate and high risk of secondary complications (endocarditis or osteomyelitis). They supported this recommendation by citing two previous reports (only hemodialysis patients were included in one study), which showed that an attempt to salvage the catheter in patients with S. aureus infection had no more than a 20% chance of success [2, 3]. However, the paper prepared recently by the Infectious Disease Society of America commented that catheter-related infections caused by S. aureus and coagulase-negative staphylococci often respond to treatment with parental antibiotics without removal of the catheter, unless a tunnel infection has become established [4]. In addition, they recommended that catheter removal might be required if infection is recurrent or response to antibiotics is not apparent after 2 or 3 days of therapy. We recently reported that attempted Hickman catheter salvage without antibiotic lock therapy was successful in about one-half of the cases with SAB and underlying neutropenic cancer [5]. According to the definition of catheter-related infection described by Fätkenheuer et al. [1], our study included 15 possible catheter-related infections and 5 probable catheter-related infections in neutropenic cancer patients with SAB and Hickman catheter. Hickman catheters were successfully preserved in 11 (55%) of 20 cases without any complication or recurrence. Furthermore, Pigrau et al. also reported a similar catheter salvage rate [55% (11 episodes/20 episodes)] in patients with catheter-related SAB (any kind of central venous catheter was included in this study) [6]. Besides this, Sotman et al. reported that there was no clinical or postmortem evidence of endocarditis in 32 neutropenic patients with SAB and leukemia [7]. They proposed the hypothesis that prolonged thrombocytopenia may prevent the formation of vegetation and prompt empiric antibiotic therapy of the neutropenic patients may serve to prevent endocarditis. Recently, Venditti et al. also reported that nonneutropenic patients with SAB were more susceptible to early complications such as severe sepsis or septic shock and to later ones such as endocarditis and metastatic abscesses than neutropenic patients with SAB were [8]. In summary, we believe that salvage success rate for possible Hickman catheter-related SAB in neutropenic cancer patients may not be as low as the previous studies suggested and that the risk of complications of SAB (i.e., endocarditis) in neutropenic patients may not be as high as that in nonneutropenic patients. …