Long-term central venous access vs other home therapies: complications in patients with acquired immunodeficiency syndrome.
One hundred and forty silicone catheters were inserted in 127 patients for long-term intravenous access with a cumulative follow-up time of 21,125 catheter-days (58 patient-years). Fifty-six patients had acquired immunodeficiency syndrome (AIDS); 44 were not AIDS patients and were receiving ambulatory home parenteral nutrition, whereas the remaining 27 did not have AIDS and were receiving home antibiotic therapy. Patients had a mean of 1.1 catheters inserted, and the rate of Hickman catheter-related sepsis was 0.18 per 100 catheter days or 0.6 septic episodes per patient year of treatment. Catheter-related sepsis was higher in AIDS patients (p < .01) and in patients receiving parenteral nutrition (p < .05) compared with those receiving antibiotic therapy. Prior catheter infection and AIDS were the most significant predictors of catheter infection (p < .01). Staphylococcus aureus was the most commonly isolated pathogen (61%) in AIDS patients. Fever (p < .001) and relative leukocytosis (p < .02) were the most common signs of infection. Only 14 infected catheters (37.8%) were salvaged by antibiotic therapy after the initial infection episode, and 6 of these catheters (42.9%) had recurrent multiple infections. In addition, inflammatory bowel disease was found to be a risk factor for venous thrombosis (p = .018). We conclude that because immunocompromised patients have a high risk of infection, catheter-related sepsis in these patients should be treated by catheter removal and antibiotics.
Mukau
L
L
Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, Maryland.
Talamini
M A
MA
Sitzmann
J V
JV
Burns
R C
RC
McGuire
M E
ME
D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000209:etiology; D004866:Equipment Contamination; D005500:Follow-Up Studies; D006801:Humans; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology; D013997:Time Factors
D000900:Anti-Bacterial Agents