Serious complications of vascular catheter-relatedStaphylococcus aureus bacteremia in cancer patients

Abstract

Over the period 1986 to 1989, 53 cancer patients were identified with catheter-related Staphylococcus aureus bacteremia at the University of Texas M.D. Anderson Cancer Center. Septic thrombosis was diagnosed in 12 (23%) patients and was suspected in another 3 (6%). Of the 12 patients, five developed deep-seated infections (septic emboli, endocarditis, meningitis, abscess), compared with 2 of the 38 other patients with no septic thrombosis (p < 0.01). Fever persisted for more than three days after antibiotic initiation in 52% of the patients with complications (septic thrombosis and/or deep-seated infections), compared with 19% of those without complications (p < 0.02). Of the three patients with complications who were treated for 14 days with intravenous antistaphylococcal antibiotics, two relapsed; in contrast, all of the nine patients with complications who were treated for more than 14 days (mean 4 weeks) were cured, and none relapsed (p < 0.05). Of the nine patients with complications who were treated with a long course of therapy, only one required surgery. The possibility of septic thrombosis and/or deep-seated infections should be considered in all cancer patients with catheter-related Staphylococcus aureus bacteremia, and if present, the condition should be treated with appropriate intravenous antibiotics for at least four weeks.

Pulmonary nodules in osteosarcoma patients: differential diagnosis of central venous catheter–related infections in the lungs

“…Three cases of pulmonary septic embolism out of 231 patients with CVC is indeed a small percentage (1.3%), in agreement with other studies [6]. Pulmonary infection could have been the cause rather than the consequence of CVC infection but, given that culture of material retrieved from the distal lumen of the catheter was positive in two out of three cases, the cause of the haematopulmonary infection was far more likely to have been the CVC.…”

“…Nei nostri tre pazienti tutti i noduli polmonari che simulavano metastasi apparvero in corso di chemioterapia in pazienti con catetere venoso centrale tipo Broviac (1,3%), in accordo coi risultati di altri studi [6]. La flogosi polmonare potrebbe essere stata la causa e non la conseguenza dell'infezione del catetere venoso centrale, ma dal momento che l'esame colturale effettuato sul materiale prelevato dal lume distale del catetere fu positivo in due dei tre casi, sembrò estremamente più probabile che la causa dell'infezione emato-polmonare fosse il catetere venoso centrale.…”

“…La trombosi può essere vasale o essere localizzata nel lume del catetere; solo un terzo delle trombosi è sintomatico. Alcuni studi [2][3][4] hanno dimostrato che la trombosi è uno dei principali fattori di rischio per l'infezione del catetere venoso centrale, mentre le infezioni sono una complicanza che si verifica in circa il 15%-20% dei casi [5,6]. Gli emboli settici conseguenti a infezioni del catetere sono una complicanza ben conosciuta, pur se non frequente, anche nei pazienti pediatrici od adolescenti [6,7].…”

“…A number of studies [2][3][4] have demonstrated that thrombosis is one of the main risk factors for catheter infection whereas infections occur in 15%-20% of cases [5,6]. Septic emboli resulting from catheter infection are a wellknown but uncommon complication, even in children and adolescents [6,7].…”

Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

“…We recommend managing port-related bloodstream infections similarly to Broviac/Hickman-type catheter-related [18], a trial can be considered because our cure rate was 67% and the failures were not associated with significant morbidity. An attempt to treat with antibiotics without port removal is reasonable in cases of bloodstream infection with gramnegative bacilli, if the patient is clinically stable and has no signs of sepsis syndrome.…”