Changes in the spectrum of organisms causing bacteremia and fungemia in immunocompromised patients due to venous access devices.
A significant increase in the use of vascular access devices has changed the spectrum of organisms causing bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. This paper documents the 1988 laboratory experience with bacteremia and fungemia and contrasts some of that data with information obtained in 1984. In 1988, 439 tunnelled-catheters and 355 ports were inserted in patients; 2,778 organisms were subsequently recovered from 933 episodes of bacteremia and fungemia. Fifty-percent of the episodes of bacteremia and fungemia were vascular access device-related. Compared to 1984, the relative incidence of bacteremia due to gram-positive organisms increased from 33 to 43%, polymicrobic cultures increased from 24 to 27%, and the number of organisms with colony counts greater than 100 cfu/ml increased from 24 to 44%. In 1988, device-related sepsis was often caused by Acinetobacter spp., Bacillus spp., Corynebacterium spp., pseudomonads other than Pseudomonas aeruginosa, and coagulase-negative staphylococci. Infection was also caused by species of flavobacteria, Micrococcus, and Rhodotorula. Efforts required for identification of many of the newer pathogens have escalated material and personnel costs.
Kiehn
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TE
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Armstrong
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D000328:Adult; D002408:Catheters, Indwelling; D015169:Colony Count, Microbial; D006801:Humans; D007108:Immune Tolerance; D009181:Mycoses / Q000209:etiology / Q000382:microbiology*; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology*