Bacteremia related to IV cannulation: variability of underlying venous infection

During 1977, 22 of 66 cases of nosocomial bacteremia in our hospital were directly or indirectly attributable to infection from the intravenous (IV) site. IV-site-related bacteremia (IVSRB) occurred most frequently in patients with serious underlying disease. The characteristic clinical picture was one of fever, tachycardia, and hypotension. Signs at the IV site appeared most commonly at the onset of IVSRB but varied in time of appearance from six days before to 11 days after bacteremia. The degree of abnormality at the IV site accompanying IVSRB varied from none detectable through uncomplicated cellulitis and phlebitis to vein suppuration. Short percutaneous plastic catheters were incriminated in most cases, and gram-negative rods, especially Klebsiella and Serratia, were the most frequent infecting bacteria. Initial treatment consisted of removal of the IV cannula and administration of parenteral antibiotics. Although no deaths could be attributed to recognized and treated IVSRB, it resulted in significant morbidity including the need for excision of veins contiguous with the IV site in six patients.