Febrile Neutropenia in Patients with Acute Leukemia with Long-Term Central Venous Access in Kuwait: Microbial Spectrum, Outcome and Catheter Management

Abstract

Objective: This study was conducted to investigate the microbial spectrum, outcome and catheter management in febrile neutropenic acute leukemia patients with long-term central venous access, at a single center in Kuwait. Methods: One hundred and thirty-three febrile neutropenic episodes in 64 adult acute leukemia patients with long-term central venous access encountered at the Kuwait Cancer Control Centre were studied. The frequency of clinically documented infections, microbiologically documented infections, fevers of unknown origin and catheter-related infection was determined. Response to treatment and the need for catheter removal were studied. Results: In the 133 febrile neutropenic episodes, clinically documented infections, microbiologically documented infections and fever of unknown origin occurred in 12.8, 30.8 and 56.4%, respectively. Thirty-two episodes of catheter-related infections were encountered. Gram-positive and gram-negative infections occurred in equal frequency. Escherichia coli and methicillin-resistant Staphylococcus aureus were the most frequent organisms. Of all episodes, 87.2% responded to antibiotics and 11 episodes required removal of the catheter. Of the clinically documented infections, 76.5% of the episodes responded to treatment without catheter removal. Of the microbiologically documented episodes, 68.3% were treated successfully without removal of the catheter. One hundred percent of the episodes of fever of unknown origin responded to a broad spectrum of antibiotics, without catheter removal. Conclusion: Gram-negative and gram-positive infections occur in equal frequency in febrile neutropenic acute leukemia patients with long-term central venous catheters. E. coli and methicillin-resistant S. aureus are the most frequent organisms and the majority of the episodes are curable by antimicrobial therapy without the removal of the catheter.