STAPHYLOCOCCUS-AUREUS CATHETER-ASSOCIATED BACTEREMIA - MINIMAL EFFECTIVE THERAPY AND UNUSUAL INFECTIOUS COMPLICATIONS ASSOCIATED WITH ARTERIAL SHEATH CATHETERS

Objective: To determine factors that predict complications and examine outcomes of Staphylococcus aureus bacteremia according to the duratio n of antibiotic therapy. Methods: Clinical data were extracted from ch arts of patients with positive blood cultures for S aureus at a single institution during a 2-year period. Results: Of 102 patients with S a ureus bacteremia, 55 were considered to have bacteremia attributable t o an intravascular catheter, including five patients who were bacterem ic after percutaneous transluminal coronary angioplasty. Among the oth er 50 patients with S aureus catheter-associated bacteremia, infection was community acquired in 18 and nosocomial in 32. Septic pulmonary e mboli were more common in patients with community-acquired S aureus ca theter-associated bacteremia, most of whom had Hickman catheters or ve nous access disks. Delayed removal of the infected catheter was associ ated with persistence of bacteremia (P=.01). With patients with early complications excluded, patients treated for 10 to 15 days had clinica l characteristics similar to those of patients treated with longer cou rses of antibiotics and had similarly low rates of relapse (0% vs 4.7% ). In contrast, treatment with parenteral antibiotics for less than 10 days appeared to be inadequate in that relapse occurred in two of thr ee such patients. Staphylococcus aureus catheter-associated bacteremia associated with percutaneous transluminal coronary angioplasty was co mplicated by a femoral artery mycotic aneurysm in two of five patients . Conclusion: Approximately one third of S aureus catheter-related bac teremias were community acquired, reflecting increased usage of intrav ascular devices for home parenteral support. A 10- to 15-day course of parenteral antibiotics was equivalent to longer courses of therapy in patients without early complications.