REPLY
Catheter-related Bacteremias in Patients with Cancer
Jeffrey S. Groeger, MD;
Arthur E. Brown, MD; and
Donald Armstrong, MD
1 July 1994 | Volume 121 Issue 1 | Pages 72-73
IN RESPONSE:
We noted that potential factors contributing to catheter-related bacteremia include poor device care technique at home, in the clinic, or in the hospital; increased frequency of device flushing; and contamination of infusate [1, 2] or catheter hubs [3]. To highlight this point, "water-borne" gram-negative bacilli are grouped separately from other pathogens. We compared the incidence of bacteremia (as defined in our article [4]) occurring in 985 Hickman-type catheters flushed daily with the incidence occurring in 582 devices flushed twice weekly when not in continual use. The switch to a twice-weekly home care regimen was associated with a 10% reduction in bacteremias with no increase in clinical thrombosis rate [5].
We did not report the relative degree or duration of neutropenia because data were only available for those patients with proven or suspected infection. The absolute neutrophil count, recorded at the time of catheter-related bacteremia, showed no statistical difference among patients with solid tumor, leukemia, or lymphoma and multiple myeloma; patients with the acquired immunodeficiency syndrome; or patients undergoing bone marrow transplantation. The median absolute neutrophil counts (x 109/L) for these groups were 2.7, 1.8, 2.8, 3.2, 2.0, and 1.4, respectively.
Further investigation is required to categorically determine whether neutropenia is a significant risk factor for catheter-related bacteremia. Device-related bacteremia appears to be greatest in patients requiring frequent device use and flushing. Bacteremias are less frequent with totally implanted port devices because of the reduced need for device manipulation, the absence of required home care, and use in patients receiving less marrow-toxic chemotherapy.
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Author and Article Information
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Memorial Sloan-Kettering Cancer Center; New York, NY 10021
1. Maki DG. Infections associated with intravascular lines. In: Remington JS, Swartz MN, eds. Current Clinical Topics in Infectious Diseases. New York: McGraw-Hill; 1980:309-63.
2. Maki DG, Alvarado CJ. The role of clinical microbiology laboratory in diagnosis of infusion related sepsis. Clin Microbiol. 1982; 4:89-94.
3. Linares J, Sitges-Serra A, Garau J, Perez JL, Martin R. Pathogenesis of catheter sepsis: A prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbiol. 1985; 21:357-60.
4. Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, et al. Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med. 1993; 119:1168-74.
5. Lucas AB, Groeger JS. A prospective evaluation of Hickman catheter morbidity with twice weekly flushing compared to daily flushing. International Consensus on Supportive Care in Oncology. Brussels, Belgium; 1990.
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