Nosocomial sepsis associated with interleukin-2.
OBJECTIVE
To determine the incidence, clinical magnitude, and risk factors for nosocomial bacteremia in patients given interleukin-2 with or without (+/-) lymphokine activated killer (LAK) cells for cancer immunotherapy.


METHODS
Cohort study.


METHODS
Clinical study unit of tertiary medical center.


METHODS
All patients entering the interleukin-2 +/- LAK cancer immunotherapy protocol during a 28-month period. Control groups were patients in a surgical intensive care unit, patients receiving total parenteral nutrition, and patients with solid tumors.


RESULTS
Twenty of 107 (19%) interleukin-2-treated patients developed sepsis; in 12 of these patients, sepsis was intravenous catheter-associated. The bacteremia rate among patients receiving total parenteral nutrition, in the surgical intensive care unit, or having solid tumors was 2.8%, 4.1%, and 1.9%, respectively. Staphylococcus aureus was the pathogen in 13 courses; Staphylococcus epidermidis, in 5; and Escherichia coli, in 2. Two patients died; three developed suppurative thrombophlebitis; one developed septic arthritis; one, septic arterial aneurysm; and one, peritonitis with probable meningitis. Colonization with S. aureus increased the risk of S. aureus bacteremia 6.3-fold (95% CI, 2.8 to 14.5; P less than 0.001); skin desquamation at the catheter site increased the relative risk 2.0-fold (95% CI, 1.3 to 3.1; P = 0.031). Both colonization with S. aureus and skin desquamation increased the relative risk of S. aureus bacteremia 14.5-fold (95% CI, 4.1 to 50.9; P less than 0.0001).


CONCLUSIONS
Staphylococcal bacteremia is more frequent in patients receiving interleukin-2 therapy and is associated with substantial morbidity and toxic skin reactions.
New England Medical Center, Boston, Massachusetts.
D R
DR
Snydman
B
B
Sullivan
M
M
Gill
J A
JA
Gould
D R
DR
Parkinson
M B
MB
Atkins
D000328:Adult; D002406:Catheterization, Peripheral / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003627:Data Interpretation, Statistical; D004927:Escherichia coli Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000008:administration & dosage / Q000009:adverse effects*; D015979:Killer Cells, Lymphokine-Activated; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012867:Skin / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis
D007376:Interleukin-2