Changing epidemiology of bloodstream infections associated with central venous catheters in patients after stem cell transplantation: increasing frequency of identification of Gram-negative pathogens

Anis Raddaoui; Khaoula Mezzi; Dorra Belloumi; Siwar Frigui; Tarek Ben Othmen; Nour Abdejlil; Yosra Chebbi; Wafa Achour

Authors

Anis Raddaoui Laboratory Department, National Bone Marrow Transplant Center, Tunisia , Tunis El Manar University https://orcid.org/0000-0003-0293-9735
Khaoula Mezzi Laboratory Department, National Bone Marrow Transplant Center, Tunisia , Tunis El Manar University
Dorra Belloumi Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia
Siwar Frigui Laboratory Department, National Bone Marrow Transplant Center, Tunisia , Tunis El Manar University https://orcid.org/0009-0003-5675-7969
Tarek Ben Othmen Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia
Nour Abdejlil Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia
Yosra Chebbi Laboratory Department, National Bone Marrow Transplant Center, Tunisia , Tunis El Manar University
Wafa Achour Laboratory Department, National Bone Marrow Transplant Center, Tunisia , Tunis El Manar University

Keywords:

bloodstream infection, central venous catheter, transplant-hematopoietic stem cell, antibiotic resistance

Abstract

Introduction. The frequent use of central venous catheters (CVC) in hematopoietic stem cell (HSC) transplant patients exposes them to a high risk of catheter-related bloodstream infections (CRBSI). The aim of this study was to estimate the prevalence of CRBSI in HSC transplant patients, and to describe their clinical and bacteriological characteristics.
Material and methods. A retrospective study (January 2011-December 2022) including 60 episodes of CRBSI occurring in the pre- or post-HSC transplant period, in 56 patients was conducted in the Hematology and Transplant Department of the National Bone Marrow Transplant Centre.
Results. The prevalence of CRBSI was 4.9%. The median time between CVC placement and CRBSI was nine days. Gram-negative bacilli (GNB) CRBSI (N=33, 55%), were more frequent than gram-positive cocci (GPC) CRBSI (N=27, 45), with a GNB/GPC ratio of less than one before 2019, rising to two between 2019 and 2022. First-line antibiotic therapy was based mainly on Piperacillin-tazobactam (60%). Removal of the CVC was indicated in 51% of cases. Mortality associated with CRBSI was 0.32% (4/1217).
Conclusions. The increase in CRBSI prevalence and the high rate of antibiotic resistance highlight the need for heightened awareness, continuous healthcare staff training, and judicious antibiotic use.

Downloads

Download data is not yet available.

Author Biographies

Anis Raddaoui, Laboratory Department, National Bone Marrow Transplant Center, Tunisia, Tunis El Manar University

Laboratory Department, National Bone Marrow Transplant Center, Tunisia.
University of Tunis El Manar, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia.
Khaoula Mezzi, Laboratory Department, National Bone Marrow Transplant Center, Tunisia, Tunis El Manar University

Laboratory Department, National Bone Marrow Transplant Center, Tunisia.
University of Tunis El Manar, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia.
Dorra Belloumi, Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia

Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia.
Siwar Frigui, Laboratory Department, National Bone Marrow Transplant Center, Tunisia, Tunis El Manar University

Laboratory Department, National Bone Marrow Transplant Center, Tunisia.
University of Tunis El Manar, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia.
Tarek Ben Othmen, Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia

Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia.
Nour Abdejlil, Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia

Hematology and Transplant Department, National Bone Marrow Transplant Center, Tunisia.
Yosra Chebbi, Laboratory Department, National Bone Marrow Transplant Center, Tunisia, Tunis El Manar University

Laboratory Department, National Bone Marrow Transplant Center, Tunisia.
University of Tunis El Manar, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia.
Wafa Achour, Laboratory Department, National Bone Marrow Transplant Center, Tunisia, Tunis El Manar University

Laboratory Department, National Bone Marrow Transplant Center, Tunisia.
University of Tunis El Manar, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia.

References

Tsuboi M, Hayakawa K, Mezaki K, Katanami Y, Yamamoto K, Kutsuna S, et al. Comparison of the epidemiology and microbiology of peripheral line- and central line-associated bloodstream infections. Am J Infect Control. 2019 Feb;47(2):208-210. doi:10.1016/j.ajic.2018.08.016.

Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020 Sep 7;10(1):118. doi:10.1186/s13613-020-00713-4.

Böll B, Schalk E, Buchheidt D, Hasenkamp J, Kiehl M, Kiderlen TR, et al. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2021 Jan;100(1):239-259. doi:10.1007/s00277-020-04286-x.

Aksoy F, Karakoc Parlayan HN, Agirman M, Ozkaya E, Sonmez M, Yilmaz G. Retrospective evaluation of the incidence, clinical characteristics and outcomes of Gram-negative bacterial infections in patients with hematologic malignancies. Pathogens. 2025 Dec 4;14(12):1238. doi:10.3390/pathogens14121238.

Centers for Disease Control and Prevention. Bloodstream infection event: central line-associated bloodstream infection and non-central line associated bloodstream infection [Internet]. Atlanta: CDC; 2026 Jan. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf

Société Française de Microbiologie. Référentiel en microbiologie médicale: REMIC [Internet]. Paris: Société Française de Microbiologie; [cited 2023 Nov 1]. Available from: https://www.sfm-microbiologie.org/boutique/referentiel-en-microbiologie-medicale-remic/

Li J, Zheng Y, Ma J, Zhang Y, Dong H, Chen L, et al. The relationship between catheter-related bloodstream infection and multi-drug resistant bacteria: a five-year retrospective study. BMC Infect Dis. 2025 Aug 6;25(1):988. doi:10.1186/s12879-025-11367-7.

McDonald MK, Culos KA, Gatwood KS, Prow C, Chen H, Savani BN, et al. Defining incidence and risk factors for catheter-associated bloodstream infections in an outpatient adult hematopoietic cell transplantation program. Biol Blood Marrow Transplant. 2018 Oct;24(10):2081-2087. doi:10.1016/j.bbmt.2018.04.031.

Ali N, Adil SN, Shaikh MU. Bloodstream and central line isolates from hematopoietic stem cell transplant recipients: data from a developing country. Transpl Infect Dis. 2014 Feb;16(1):98-105. doi:10.1111/tid.12176.

Ardura MI, Bibart MJ, Mayer LC, Guinipero T, Stanek J, Olshefski RS, et al. Impact of a best practice prevention bundle on central line-associated bloodstream infection (CLABSI) rates and outcomes in pediatric hematology, oncology, and hematopoietic cell transplantation patients in inpatient and ambulatory settings. J Pediatr Hematol Oncol. 2021 Jan;43(1):e64-e72. doi:10.1097/MPH.0000000000001950.

Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, et al. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One. 2020 Jan 24;15(1):e0227772. doi:10.1371/journal.pone.0227772.

Willis DN, Looper K, Malone RA, Ricken B, Slater A, Fuller A, et al. Eliminating central line associated bloodstream infections in pediatric oncology patients: a quality improvement effort. Pediatr Qual Saf. 2023 May 29;8(3):e660. doi:10.1097/pq9.0000000000000660.

Lepape A, Machut A, Savey A. Réseau national Réa-Raisin de surveillance des infections acquises en réanimation adulte: méthodes et principaux résultats. Med Intensive Rea. 2018 May;27(3):197-203. doi:10.3166/rea-2018-0042.

Bell T, O’Grady NP. Prevention of central line-associated bloodstream infections. Infect Dis Clin North Am. 2017 Sep;31(3):551-559. doi:10.1016/j.idc.2017.05.007.

Fahy B, Sockrider M. Central venous catheter. Am J Respir Crit Care Med. 2019 Jun 1;199(11):P21-P22. doi:10.1164/rccm.19911P21.

de Grooth HJ, Hagel S, Mimoz O. Central venous catheter insertion site and infection prevention in 2024. Intensive Care Med. 2024 Nov;50(11):1897-1899. doi:10.1007/s00134-024-07664-5.

Carter JH, Langley JM, Kuhle S, Kirkland S. Risk factors for central venous catheter-associated bloodstream infection in pediatric patients: a cohort study. Infect Control Hosp Epidemiol. 2016 Aug;37(8):939-945. doi:10.1017/ice.2016.83.

Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS. 2017 Apr;125(4):365-375. doi:10.1111/apm.12665.

Yokota PKO, Marra AR, Belucci TR, Victor ES, Dos Santos OFP, Edmond MB. Outcomes and predictive factors associated with adequacy of antimicrobial therapy in patients with central line-associated bloodstream infection. Front Public Health. 2016 Dec 23;4:284. doi:10.3389/fpubh.2016.00284.

Agrawal SK, Gautam H, Choudhary AH, Das BK, Kumar L, Kapil A. Central line-associated bloodstream infections in cancer patients: an experience from a tertiary care cancer centre. Indian J Med Microbiol. 2019 Jul-Sep;37(3):376-380. doi:10.4103/ijmm.IJMM_19_352.

Gao T, Zhu X, Zeng Q, Li X, Luo M, Yu C, et al. Peripherally inserted central catheter-related bloodstream infections in patients with hematological malignancies: a retrospective 7-years single-center study. Am J Infect Control. 2022 Oct;50(10):1171-1177. doi:10.1016/j.ajic.2022.01.016.

See I, Freifeld AG, Magill SS. Causative organisms and associated antimicrobial resistance in healthcare-associated, central line-associated bloodstream infections from oncology settings, 2009-2012. Clin Infect Dis. 2016 May 15;62(10):1203-1209. doi:10.1093/cid/ciw113.

He Y, Zhao H, Wei Y, Gan X, Ling Y, Ying Y. Retrospective analysis of microbial colonization patterns in central venous catheters, 2013-2017. J Healthc Eng. 2019 Sep 17;2019:8632701. doi:10.1155/2019/8632701.

Pinelli F, Cecero E, Degl’Innocenti D, Selmi V, Giua R, Villa G, et al. Infection of totally implantable venous access devices: a review of the literature. J Vasc Access. 2018 May;19(3):230-242. doi:10.1177/1129729818758999.

Guimarães T, Borges IC, Spadão FS, Mariano L, Nascimento MM, Higashino H, et al. Impact of discontinuing levofloxacin prophylaxis on bloodstream infections in neutropenic hematopoietic stem cell transplantation patients. Antibiotics (Basel). 2022 Sep 19;11(9):1269. doi:10.3390/antibiotics11091269.

Van der Mee-Marquet N, Decalonne M, Gimenes R, Goube F. Surveillance des infections associées aux dispositifs invasifs: mission nationale SPIADI. Résultats de la surveillance menée en 2019. Île-de-France: SPIADI; 2019.

Asaad AM, Ansar Qureshi M, Mujeeb Hasan S. Clinical significance of coagulase-negative staphylococci isolates from nosocomial bloodstream infections. Infect Dis (Lond). 2016 May;48(5):356-360. doi:10.3109/23744235.2015.1122833.

Lee YM, Moon C, Kim YJ, Lee HJ, Lee MS, Park KH. Clinical impact of delayed catheter removal for patients with central-venous-catheter-related Gram-negative bacteraemia. J Hosp Infect. 2018 May;99(1):106-113. doi:10.1016/j.jhin.2018.01.004.

Van den Bosch CH, Kops AL, Loeffen YGT, van der Steeg AFW, van de Wetering MD, Fiocco MF, et al. Central venous catheter-related bloodstream infections caused by Enterobacterales in pediatric oncology patients: catheter salvage or removal. Pediatr Infect Dis J. 2024 Jan 1;43(1):49-55. doi:10.1097/INF.0000000000004106.

Devrim İ, Ergun D, Demet Payza A, Ozbakir H, Boztaş Demir AE, Kaçar P, et al. The impact of a bundle for the prevention of central venous catheter-associated bloodstream infections in an pediatric surgery intensive care unit. GMS Hyg Infect Control. 2025 Sep 23;20:Doc55. doi:10.3205/dgkh000584.

World Health Organization. New guidance aims to reduce bloodstream infections from catheter use [Internet]. Geneva: WHO; 2024 May 9. Available from: https://www.who.int/fr/news/item/09-05-2024-new-guidance-aims-to-reduce-bloodstream-infections-from-catheter-use