[Totally implantable, permanent central venous catheter systems in AIDS patients--a method for home care or an unacceptable infection risk?]

Aim of the prospective study was to evaluate the infection risk of port-a-Cath-systems in AIDS patients and the prognosis of these catheter related complications. Over a 5-year period (December 1989 through November 1994) 50 port-a-Cath-systems were implanted in 44 AIDS patients. 77.2% of the patients were homosexuals, 20.5% were iv drug abusers. In 68% the indication for implantation of the catheter was prophylactic parenteral treatment in CMV retinitis. The mean duration of catheter use was 131.5 +/- 100.4 days (range = 7-421 days). 20 (40%) catheter-related infections occurred, thus implying an infection rate of 0.3 infections per 100 catheter days without difference between the risk groups of patients. Homecare was associated with an infection rate of 0.26 infections/100 catheter days compared with 1.0 infections/100 catheter days in in-patients. The most frequent causative organisms (75% of the infections) were staphylococci (40% Staphylococcus epidermidis). 19/20 infected catheters had to be removed after treating the patients by antimicrobial agents for a mean of 9.63 +/- 1.92 days. In 5/19 cases the germ was eradicated for a short period of time, but in every case bacteremia relapsed and the catheter had to be explanted. In one patient antimicrobial chemotherapy alone was successful. 30 patients died, 4 (13.3%) due to generalized bacterial infection. Based on these results, port-a-Cath-systems are helpful and safe devices for patient-centered and cost-effective care of AIDS patients at home.