T. Doellmann

Medizinische Hochschule Hannover

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Meinolf Karthaus

München Klinik Neuperlach

Arnold Ganser

Medizinische Hochschule Hannover

T. Klimasch

Medizinische Hochschule Hannover

G. Heil

Medizinische Hochschule Hannover

J Krauter

Klinikum Braunschweig

G. Huebner

Viterbo University

Christine Elser

University Health Network

C. Julian Rosenthal

Klinikum im Friedrichshain

Cooperative Institutions

Medizinische Hochschule Hannover

GTx (United States)

University of Toronto

Heinrich Heine University Düsseldorf

München Klinik Neuperlach

München Klinik Harlaching

München Klinik

Bayer (Germany)

Grand Charleroi Hospital

Marqués de Valdecilla University Hospital

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Central Venous Catheter Infections in Patients with Acute Leukemia

Chemotherapy (2002)

Meinolf Karthaus T. Doellmann T. Klimasch J Krauter G. Heil

Background: Central venous catheters (CVCs) have become an essential tool for an appropriate management of patients with acute leukemia. Infectious complications are a major concern in patients treated for acute leukemia. Although CVC-related infections are considered to be a major source of infections during neutropenia (<500/µl), data regarding the incidence of CVC-related infections are rare in acute leukemia. Patients and Methods: We analyzed nontunneled CVCs in 58 patients with acute leukemia (22 men/36 women) in 119 chemotherapy cycles from April 1996 to January 1998 in a prospective trial. Proven CVC-related infection was defined as the isolation of the same organism from peripheral blood and CVC tip. CVC infection was suspected or possible when exit site inflammation and positive blood culture or organisms typical for CVC infection were observed. Results: Mean neutropenia/cycle was 16.3 days (SD 8.0). 178 CVCs with 2,576 CVC days (mean 14.5 days, SD 7.2 days) were used in 119 cycles. Fever occurred in 87 cycles (73%). Blood stream infection was proven in 31 out of 87 febrile episodes (26.1%) with 40 isolates (8 gram-negative, 31 gram-positive, 1 Candida spp.). Colonization of the CVC tip was observed in 24 CVC lines with 28 isolates (27 gram-positive, 1 gram-negative); however, proven CVC-related infections were observed in 5 episodes only, all with coagulase-negative staphylococci. In another 6 episodes, CVC-related infection was assumed (local inflammation and gram-positive blood culture). Six further episodes had typical blood isolates (4 coagulase-negative staphylococci, 1 Candida spp.) and were considered possible CVC-related infections. In none of the remaining afebrile 32 cycles was a CVC infection observed or suspected. Conclusion: Gram-positive organisms contributed to the majority of CVC-related infections (16 out 17 CVC infections); however, the overall incidence of CVC infections in acute leukemia patients was 6.5/1,000 CVC days only (1.9 proven/2.3 suspected/2.3 possible/1,000 CVC days).

Central venous catheter

10.1159/000064922

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Citations (30)

Improvement of ultrasound with digital documentation in cancer patients

European Journal of Cancer (1999)

Meinolf Karthaus T. Doellmann G. Huebner Arnold Ganser

10.1016/s0959-8049(99)81883-8

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Incidence of Central Venous Catheter (CVC)-lnfections in Patients with Acute Leukemia

Hämatologie und Bluttransfusion (2001)

Meinolf Karthaus T. Doellmann T. Klimasch J Krauter G. Heil

Central venous catheter

10.1007/978-3-642-18156-6_55

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Intensive Intravenous Amphotericin B for Prophylaxis of Systemic Fungal Infections

Chemotherapy (2000)

Meinolf Karthaus T. Doellmann T. Klimasch Christine Elser C. Julian Rosenthal

Background: Invasive fungal infections are an increasing cause of morbidity in acute leukemia (AL) patients. Methods: In a prospective pilot trial, the safety and efficacy of antifungal prophylaxis with intravenous (i.v.) amphotericin B (AMB; 1 mg/kg every 48 h) was studied in 46 consecutive cycles. Prophylaxis with i.v. AMB was carried out in patients treated with intensive chemotherapy for AL and compared with a control of 49 cycles without prophylaxis. Results: Pulmonary infiltrates (5 vs. 23; p < 0.001) and fungal microabscesses in the liver or spleen (0 vs. 6; p = 0.014) occurred significantly less frequently in the prophylaxis group. While there were 3 deaths related to systemic fungal infections in the control group, there were none in the prophylaxis group. Escalation to conventional AMB (1.0 mg/kg/day) was significantly less frequent in the prophylaxis group (9 out of 46 cycles) compared with the control arm (29 out of 49 cycles; p = 0.001). A total of 695 mg of AMB per cycle was administered in the prophylaxis arm, compared with 634 mg/cycle for empirical treatment in the control group (p = 0.6). Infusion-related toxicity was documented in 29% of the cycles of prophylaxis compared with 55% of the cycles of empirical treatment with i.v. AMB in the control group. The nephrotoxicity of AMB prophylaxis was moderate, with ≥ WHO degree II reported in 1 out of 46 cycles only. Conclusion: Intensive i.v. AMB prophylaxis reduced invasive fungal infections and led to a reduction in fungal microabscesses in the liver or spleen, as well as pulmonary infiltrates, in patients treated for AL. The need for escalation to empirical i.v. AMB treatment was significantly reduced. Intensive AMB prophylaxis was feasible, with moderate adverse effects.

10.1159/000007301

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Citations (20)