Central venous line infections in AIDS

The relative infection rates of Port-a-Cath and Hickman lines used for the maintenance treatment of cytomegalovirus retinitis were studied by retrospective casenote review. Seventy-five lines were inserted over an 18 month period. The overall infection rates were significantly greater for Hickman lines: 0.97/100 line-days compared to 0.39/100 line-days for Port-a-Caths, with a trend towards higher infection rates in those prescribed ganciclovir. A total of 56 episodes of septicaemia were recorded with a significantly greater incidence of septicaemia within 1 month of line insertion in those with a neutrophil count < 1.0 x 10(3)/mm3. Ten infectious episodes were associated with death, six of which were due to Pseudomonas spp.

In HIV seropositive patients, use of a Port-a-Cath is associated with a significantly lower rate of line associated sepsis than use of a Hickman line. Insertion of long term central venous catheters should be avoided if possible when the neutrophil count is < 1.0 x 10(3)/mm3.