Abstract
The medical records of 90 pediatric pts on HTPN during 1976-1984(63,490 pt days) were analyzed to determine the type, incidence, source and complications of catheter infections. There were 99 episodes of confirmed catheter infections(1/641 therapy days), 19 at the catheter insertion site. 42 pts accounted for the 99 episodes of infection; 18 were infected once and 9 pts had 45 episodes(4-6 each). Organisms responsible were:S. aureus(38%); S. epidermitis(30%); Candida spp.(ll%); P. aeruginosa(9%); E. coli(6%); Gp. D Streptococcus; Klebsiella; S. viridans and Ptyrosporum Orbicularis. Positive catheter blood cultures were obtained 80% of the time in suspected sepsis and half of these had simultaneous positive peripheral blood cultures. Catheter related sepsis(staphylococcal) was the cause of death in 6 cases. 47 pts were never infected and the duration of therapy was comparable to that of the infected group. The catheter was removed in 70/76 episodes of infection prior to 1981 when catheters were systematically removed when infected, mostly due to S. aureus, gram negatives and fungal. Subsequently, 23/29 infectious episodes were treated successfully as outpatients for 4-6 weeks, following induction of antibiotic therapy as inpatients; 28/29 were staphylococcal infections. No correlation was found between initial diagnosis, age or catheter site and incidence of infection. In one pt the source of infection was a contaminated solution. Catheter sepsis is a complication which occurs often in a few pts, occasionally in others and never in some. Staphylococcal infections may, in many instances, be eradicated without catheter removal.
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