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Long-term central venous access vs other home therapies: complications in patients with acquired immunodeficiency
L Mukau1, M A Talamini, J V Sitzmann
1Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, Maryland.
Insights
Long-term silicone catheters in immunocompromised patients, particularly those with acquired immunodeficiency syndrome (AIDS) or on parenteral nutrition, showed a high risk of sepsis. Catheter removal and antibiotics are recommended for treating catheter-related infections in these high-risk groups.
Area of Science:
- Infectious Diseases
- Medical Devices
- Immunocompromised Hosts
Background:
- Long-term intravenous catheters are crucial for managing patients requiring extended medical support.
- Immunocompromised patients, including those with acquired immunodeficiency syndrome (AIDS), face elevated risks of infection.
- Catheter-related sepsis poses a significant threat to patient safety and treatment efficacy.
Purpose of the Study:
- To evaluate the incidence and risk factors of Hickman catheter-related sepsis in a diverse patient population.
- To compare sepsis rates among patients with AIDS, those on home parenteral nutrition, and those receiving home antibiotic therapy.
- To identify predictors of catheter infection and assess the effectiveness of salvage therapies.
Main Methods:
- A retrospective analysis of 140 silicone catheters inserted in 127 patients over a cumulative follow-up of 21,125 catheter-days.
- Categorization of patients into groups: AIDS, home parenteral nutrition, and home antibiotic therapy.
- Statistical analysis to determine sepsis rates, risk factors, and predictors of infection.
Main Results:
- The overall rate of Hickman catheter-related sepsis was 0.18 per 100 catheter days.
- Sepsis rates were significantly higher in patients with AIDS (p < .01) and those on parenteral nutrition (p < .05) compared to antibiotic therapy recipients.
- Prior catheter infection and AIDS were identified as the most significant predictors of infection (p < .01).
- Staphylococcus aureus was the predominant pathogen in AIDS patients (61%).
- Fever and relative leukocytosis were the most common signs of infection.
- Only 37.8% of infected catheters were salvaged with antibiotics, with high recurrence rates.
- Inflammatory bowel disease was a risk factor for venous thrombosis (p = .018).
Conclusions:
- Immunocompromised patients are at a high risk for catheter-related sepsis.
- Catheter-related sepsis in these high-risk populations warrants treatment with catheter removal and antibiotics.
- The findings underscore the importance of vigilant monitoring and prompt management of catheter-related infections in vulnerable patient groups.
Abstract:
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.