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Although only one of the five patients who developed subsequent bacteraemia (the isolated case of S.?aureus CVC tip culture) was given an appropriate antibiotic (to which the isolate was susceptible within 48?h after CVC removal), none died of subsequent bacteraemia (Table?3). In addition, we evaluated the association between appropriate antibiotic treatment and the 28-day mortality rate. Thirty-one (19%) of 163 patients who did not receive appropriate antibiotic therapy died within 28?days after CVC Tariquidar nmr removal and 31 (21%) of 149 patients who received appropriate antibiotic therapy died (p?0.77). We also evaluated this association in 58 cases in which CVC tip cultures yielded S.?aureus. Four (21%) of 19 patients who did not receive appropriate antibiotic therapy died within 28?days after CVC removal and 11 (28%) of 39 patients who received appropriate antibiotic therapy died (p?0.75). There are limited data in the literature to guide clinicians regarding the use of antimicrobial therapy for patients with isolated positive CVC tip cultures. The current recommendation is that a febrile patient with valvular heart disease or a patient with neutropenia (absolute neutrophil count PRDX5 be observed closely for signs of infection or receive a short course (5�C7?days) of antibiotics [4]. The main finding of the present study is that BSI is rare subsequent to the removal of colonized CVCs in patients with negative concomitant blood cultures. However, there was a trend toward a more frequent occurrence of subsequent candidaemia (7.7% [3/39]; 95% CI 1.9�C21.0) than of subsequent bacteraemia (1.8% [5/273]; 95% CI 0.7�C4.3) (see Table?2), although it was not statistically significant (p?0.07). Unfortunately, in our study, each of the three patients who developed candidaemia, none of whom was given timely appropriate antifungal therapy, died of septic shock. Our data thus suggest that systemic antibiotics might be beneficial for patients whose catheter tip culture shows significant growth of Candida spp. regardless of a neutropenic status or underlying valvular heart disease. In contrast to the situation with Candida spp., no subsequent bacteraemia developed in the cases involving isolated coagulase-negative Autophagy phosphorylation staphylococci (CoNS), or Gram-negative bacilli other than P.?aeruginosa. In previous studies, CVC tip cultures of S.?aureus were frequently associated with positive concomitant blood cultures [5,7,8]. In the present study, 193 (70.2%) of 275 S.?aureus CVC tip cultures were accompanied by concomitant positive blood cultures. This finding is consistent with the previous reports [7,8]. Furthermore, in two previous studies, 12% (12/77) and 14% (14/99) of patients with isolated CVC tip cultures yielding S.?aureus developed subsequent S.?aureus bacteraemia, respectively [5,6]. Interestingly, in our study only two (3.
