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. Copyright (C) 2000 S. Karger AG, Basel.