Recurrent catheter-related bloodstream infections:: risk factors and outcome

Objective: To identify risk factors for recurrent catheter related bloodstream infections (CR-BSIs). The study was undertaken at the University of Utah Hospital and involved patients who had a CR-BSI followed by catheter removal and reinsertion between January 1998 and February 2002. Design: A retrospective chart review for the cohort study of catheters initially infected, which were then followed to study risk factors for a subsequent infection. Both central tine and peripherally inserted central line catheters were included in the study. A recurrent CR-BSI was defined as positive blood cultures after three negative cultures, coupled with positive catheter tip culture or no other evident new source of infection. Results: Twenty-five (34%) of 73 patients had a recurrent CR-BSI. The first CR-BSI occurred a mean of 20.4 days after catheter insertion whereas recurrence developed a mean of 12.1 days after reinsertion (p = 0.392). Coagulase-negative staphylococci (60%) were the most common cause of recurrent infection. The recurrence was more common among the patients who were given blood product transfusion (hazard ratio (HR) 2.3; confidence interval (CI) 1.02-5.67, p = 0.049). In 20 (27%) patients, catheters were changed over a guidewire. The guidewire catheter exchange was not found to be associated with an increased risk of recurrent infection (p = 0.582). Conclusion: Catheter replacement to a new site, instead of rewiring, was not shown to decrease the risk for recurrent infection. The transfusion of blood products was associated with an increased risk for recurrent infection. (c) 2006 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.