Table 1.
Details of dataset for each of the three groups—SABX, ABL, and GWX
| Study | Study Period | No. of CRB | Type of Study/Approach | Patient Characteristics | Definition of Cure | Follow-Up (d) | Cure (%) | Recurrence with Same Organism (%) | Complications | Notes |
|---|---|---|---|---|---|---|---|---|---|---|
| SABX | ||||||||||
| Moss et al. 19907 United States | 1984–1988 | 16 | Retrospective chart review/systemic antibiotics alone | Not available for study subjects. 50% diabetic. Incident catheters | Clearance and lack of recurrent bacteremia | 28 | 4 (25) | — | None | |
| Swartz et al. 19948 United States | 1990–1993 | 29 | Prospective observational study/systemic antibiotics alone | Not available for study subjects. Incident catheters | Clinical resolution in 48 h+CVC salvage | ≥21 | 9 (31) | — | — | |
| Lund et al. 19969 United States | 1991–1992 | 22 | Retrospective chart review/systemic antibiotics alone | Not available for study subjects. Incident catheters. | Clinical resolution | 180 | 7 (31.8) | — | — | |
| Marr et al. 199710 United States | 1995–1996 | 38 | Prospective observational study/systemic antibiotics alone versus CVC removal | Median age=56 yr, 54% female. 38% diabetic. Prevalent catheters | Original CVC present at 3 mo or removal for noninfectious reason | 90 | 12 (31.6) | — | 5 (no subgroup details) | Persistent and recurrent bacteremia are in the same group—18 |
| Saad 199911 United States | 1995–1997 | 25 | Prospective observational study/systemic antibiotics alone versus GWX | Mean age=52.2 yr. 63.3% diabetic. Prevalent catheters | Lack of recurrence within 30 d | 30 | 11 (36.7) | 14 (56) | — | |
| Chawla and Nevins 200012 United States | 1986–1995 | 18 | Retrospective chart review/systemic antibiotics alone | Mean age=12.5 yr, 20% female. No patients with diabetes. Prevalent catheters | Clearance and CVC salvage | 120 | 6 (33.3) | 4 (22.2) | — | |
| Jean et al. 200213 France | 1994–1998 | 56 | Prospective observational study/systemic antibiotics alone | Mean age=59.8 yr, 30% female. 33% diabetic. Incident catheters. | Clinical resolution at 48 h and no recurrence | 90 | 29 (51.8) | — | 6 (3 shock/death, 1 spondylitis, 2 pneumonia) | |
| Lee et al. 200514 South Korea | 2001–2005 | 11 | Prospective observational study/systemic antibiotics alone versus ABL | Mean age=56 yr, 64% female. 45.5% diabetic. Prevalent catheters | Clinical resolution at 48 h and culture negative 1 wk after antibiotic completion | 21–28 | 6 (54.6) | — | — | |
| Mokrzycki et al. 20063 United States | 2000–2003 | 49 | Prospective observational study/systemic antibiotics alone versus GWX versus CVC removal and replacement versus CVC removal with alternate access | Mean age=55 yr, 44% female. 36% diabetic. Prevalent catheters | No recurrence/death in 90 d | 90 | 36 (73.5) | 10 (20.4) | 6 (no details) and 3 deaths | |
| Troidle and Finkelstein 200815 United States | 2001–2006 | 35 | Prospective observational study/removal versus GWX versus systemic antibiotics alone | Not available for study subjects. Prevalent catheters | No bacteremia/death in 60 d | 60 | 21 (60) | 5 (14.3) | 8 deaths | |
| Ashby et al. 200916 United Kingdom | — | 115 | Prospective observational study/systemic antibiotics alone versus CVC removal | Mean age=61.1 yr, 39% diabetic. Prevalent catheters | No recurrence/complication in 6 mo | 180 | 76 (66.1) | 38 (33) | 1 (no details) | Systemic antibiotics for 6 wk |
| Onder et al. 201317 United States | 1997–1998 | 95 | Retrospective chart review/systemic antibiotics alone | Mean age=14.4 yr, 48% female. Prevalent catheters | Clinical resolution at 48 ho+CVC salvage at 4 wk | 28 | 36 (37.9) | — | — | |
| Onder et al. 2013,17 2008,18 200719 United Statesa | 1999–2003 | 188 | Retrospective chart review/systemic antibiotics alone versus ABL | Mean age=13.9 yr, 56% female. Prevalent catheters | Clinical resolution at 48 h and no recurrence | 42 | 64 (34) | — | — | |
| ABL | ||||||||||
| Capdevila et al. 199320 Spain | 1990–1991 | 11b | Prospective observational study/ABL | Mean age=62.6 yr, 82% female. Incident catheters. | Clinical resolution 48–72 h+no recurrence within 6 wk | 42 | 9 (81.8) | 2 (18.2) | None | ABL: vanc/hep and cipro/hep |
| Bailey et al. 200221 United Kingdom | 2000 | 10 | Prospective observational study/ABL | Not available for study subjects. Prevalent catheters | Clinical resolution+negative cultures at 2 and 4 wk | 90 | 3 (30) | 2 (20) | 1 death | vanc/hep, gent/hep, ampho B/hep |
| Krishnasami et al. 200222 United States | 2000 | 62 | Prospective observational study/ABL versus historical catheter replacement control | Not available for study subjects. Prevalent catheters | Clinical resolution at 48 h+negative cultures at 4 wk+CVC salvage | 28 | 40 (64.5) | 0 | 11 (5 septic shock, 2 septic arthritis, 3 IE, 1 OM) | vanc/gent/hep, vanc/hep, gent/hep, cefaz/hep, cefaz/gent/hep |
| Vardhan et al. 200223 United Kingdom | — | 26 | Observational study/ABL | Not available for study subjects. Prevalent catheters | Clinical resolution at 72 h and negative cultures at 21 d | 21 | 16 (61.5) | 0 | None | vanc/gent/hep |
| Poole et al. 200424 United States | 2001–2002 | 47 | Prospective interventional study/ABL versus historical control | Mean age=54 yr, 62% female. 51% diabetic. Prevalent catheters | Clinical resolution 48 h+negative cultures at 4 wk | 28 | 33 (70.2) | 5 (10.6) | 3 (1 shock, 1 empyema, 1 infected thrombus) | vanc/ceftaz/hep, vanc/hep, or ceftaz/hep |
| Lee et al. 200514 South Korea | 2001–2005 | 18 | Prospective observational study/systemic antibiotics alone versus ABL | Mean age=61.3 yr, 56% women. 93.7% diabetic. Prevalent catheters. | Clinical resolution at 48 h and culture negative 1 wk after antibiotic completion | 21–28 | 16 (88.9) | — | — | vanc/hep, imi/hep, cipro/hep, ceftaz/hep |
| Maya et al. 200725 United States | 2002–2006 | 113 | Retrospective review of prospective database/ABL (S. aureus bacteremia only) | Mean age=52.3 yr, 55% women. 46.3% diabetic. Prevalent catheters | Clinical resolution and no recurrence in 90 d | 90 | 46 (40.7) | 27 (23.9) | 11 (5 IE, 2 OM, 1 septic arthritis, 1 shock, 1 infected thrombus, 1 chest wall abscess) | vanc/hep and cefaz/hep |
| Peterson et al. 200926 United States | 2004–2007 | 64 | Retrospective review of prospective database/ABL (VSE only) | Mean age=54.5 yr, 64% female. 66% diabetic. Prevalent catheters | Clinical resolution at 48 h and no recurrence 90 d | 90 | 39 (60.9) | 15 (23.4) | 4 (1 IE, 3 OM) | vanc/hep lock |
| Onder et al. 2013,17 201025 United Statesa | 2004–2006 | 149 | Retrospective chart review/ABL | Mean age=12.4 yr, 57% women. Prevalent catheters | CRB clearance, CVC salvage, and no infection within 6 wk | 42 | 80 (53.7) | — | — | vanc/hep, vanc/TPA, tobra/hep, tobra/TPA |
| Joshi and Hart 201225 United States | — | 46 | Prospective observational study/ABL | Mean age=47 yr, 38% women. 50% diabetic. Prevalent catheters | CRB clearance, CVC salvage, and no infection within 6 wk | 21–35 | 27 (58.7) | 0 | 1 IE | various abx mixed with either hep or citrate (amikacin, ampho B, cefaz, cefaz + gent, ceftaz, gent, gent + vanc, vanc) |
| GWX | ||||||||||
| Shaffer 199529 United States | 1992–1994 | 12 | Observational study/GWX | Not available for study subjects. Prevalent catheters | No bacteremia within 90 d | 90 | 10 (83.3) | — | None | |
| Robinson et al. 199830 United States | 1996–1997 | 23 | Prospective observational study/GWX | Mean age=59 yr, 100% women. Percent diabetic not available. Prevalent catheters | No bacteremia within 90 d | 90 | 19 (82.6) | 2 (8.7) | 1 diskitis | |
| Saad 199911 United States | 1995–1997 | 43 | Prospective observational study/systemic abx alone versus GWX | Mean age=52 yr. 58.1% diabetic. Prevalent catheters | Lack of recurrence within 30 d | 30 | 35 (81.4) | 6 (14) | — | |
| Beathard 199931 United States | 1996–1997 | 77 | Prospective observational study/GWX versus delayed placement | Mean age=53.8 yr. 48% patients with diabetes. Incident catheters. | Lack of recurrence within 45 d | 45 | 48 (62.3) | 5 (6.5) | None | |
| Tanriover et al. 200032 United States | 1997–1998 | 31 | Retrospective review of prospective database/GWX versus delayed placement | Mean age=52 yr, 58% female. 35% diabetic. Prevalent catheters | Infection-free survival | ≥21 (up to 180) | 15 (48.4) | — | 7 (no details) | |
| Mokrzycki et al. 20063 United States | 2000–2003 | 35 | Prospective observational study/systemic antibiotics alone versus GWX versus CVC removal and replacement versus CVC removal with alternate access | Mean age=57 yr, 54% female. 57% diabetic. Prevalent catheters. | No recurrence/death in 90 d | 90 | 34 (97.1) | 1 (2.9) | 1 | |
| Troidle and Finkelstein 200815 United States | 2001–2006 | 36 | Prospective observational study/removal versus GWX versus systemic abx alone | Not available for study subjects. Prevalent catheters | No bacteremia/death in 60 d | 60 | 21 (58.3) | 1 (2.8) | 8 deaths | |
| Langer et al. 201133 United States | 2001–2008 | 96 | Retrospective chart review/GWX in staphylococcal versus nonstaphylococcal bacteremiac | Mean age=57.5 yr, 51% female. 52.5% diabetic. Prevalent catheters | No bacteremia/death in the exchanged catheter | ≥21 | 55 (57.3) | — | — |
VSE, vancomycin sensitive enterococci; IE, infective endocarditis; OM, osteomyelitis; vanc, vancomycin; hep, heparin; cipro, ciprofloxacin; gent, gentamicin; ampho B, amphotericin B; cefaz, cefazolin; ceftaz, ceftazidime; imi, imipenem; TPA, tissue plasminogen activator; tobra, tobramycin.
a
Two or more publications contribute to each group, because the publications had overlapping information for the same patient populations. However, the years of patient enrollment are specific and distinguish the groups. There is no overlap of CRB cases between the Onder groups.
b
Study actually quotes data on 13 episodes of CRB. However, two of them are recurrences that occurred within the follow-up period of the initial episode and thus, have been counted as failures.
c
We grouped the staphylococcal and nonstaphylococcal infections into one group.