Frequency of infections associated with implanted systems vs cuffed, tunneled Silastic venous catheters in patients with acute leukemia
C. Severien and J. D. Nelson
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas.
A total of 75 central venous catheters were used for prolonged chemotherapy
in 39 children with acute lymphocytic leukemia and 21 patients with acute
myelocytic leukemia. Infection rates were 2.2 per 100 catheter days with
the use of cuffed, tunneled, single-lumen Silastic catheters, 2.0 per 1000
catheter days with cuffed, tunneled, double-lumen Silastic catheters, and
0.5 per 1000 catheter days with the use of implanted venous access systems.
Eighty-one percent of catheter sepsis episodes were successfully treated
without removal of the catheter. All tunnel infections required withdrawal
of the catheter for cure. The microorganisms were gram-positive bacteria in
15%, gram-negative bacteria in 7%, and fungi in 4%. Coagulase-negative
staphylococci and Pseudomonas aeruginosa were the most commonly isolated
organisms. Three of six fatal sepsis episodes were caused by disseminated
fungal infections. We conclude that the use of intracorporeal venous
catheter systems in patients with acute lymphocytic leukemia is associated
with a lower infection rate than that with cuffed, tunneled Silastic
single- or double-lumen catheters and that most septicemias can be cured
with antimicrobial therapy without removal of the catheter.
