Annals of internal medicine · 1990
Nosocomial sepsis associated with interleukin-2.
СтатьяПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Snydman D R, Sullivan B, Gill M, Gould J A, Parkinson D R, Atkins M B
Аннотация
STUDY OBJECTIVE: To determine the incidence, clinical magnitude, and risk factors for nosocomial bacteremia in patients given interleukin-2 with or without (+/-) lymphokine activated killer (LAK) cells for cancer immunotherapy.
DESIGN: Cohort study.
SETTING: Clinical study unit of tertiary medical center.
PATIENTS: All patients entering the interleukin-2 +/- LAK cancer immunotherapy protocol during a 28-month period. Control groups were patients in a surgical intensive care unit, patients receiving total parenteral nutrition, and patients with solid tumors.
MEASUREMENTS AND MAIN RESULTS: Twenty of 107 (19%) interleukin-2-treated patients developed sepsis; in 12 of these patients, sepsis was intravenous catheter-associated. The bacteremia rate among patients receiving total parenteral nutrition, in the surgical intensive care unit, or having solid tumors was 2.8%, 4.1%, and 1.9%, respectively. Staphylococcus aureus was the pathogen in 13 courses; Staphylococcus epidermidis, in 5; and Escherichia coli, in 2. Two patients died; three developed suppurative thrombophlebitis; one developed septic arthritis; one, septic arterial aneurysm; and one, peritonitis with probable meningitis. Colonization with S. aureus increased the risk of S. aureus bacteremia 6.3-fold (95% CI, 2.8 to 14.5; P less than 0.001); skin desquamation at the catheter site increased the relative risk 2.0-fold (95% CI, 1.3 to 3.1; P = 0.031). Both colonization with S. aureus and skin desquamation increased the relative risk of S. aureus bacteremia 14.5-fold (95% CI, 4.1 to 50.9; P less than 0.0001).
CONCLUSIONS: Staphylococcal bacteremia is more frequent in patients receiving interleukin-2 therapy and is associated with substantial morbidity and toxic skin reactions.
DESIGN: Cohort study.
SETTING: Clinical study unit of tertiary medical center.
PATIENTS: All patients entering the interleukin-2 +/- LAK cancer immunotherapy protocol during a 28-month period. Control groups were patients in a surgical intensive care unit, patients receiving total parenteral nutrition, and patients with solid tumors.
MEASUREMENTS AND MAIN RESULTS: Twenty of 107 (19%) interleukin-2-treated patients developed sepsis; in 12 of these patients, sepsis was intravenous catheter-associated. The bacteremia rate among patients receiving total parenteral nutrition, in the surgical intensive care unit, or having solid tumors was 2.8%, 4.1%, and 1.9%, respectively. Staphylococcus aureus was the pathogen in 13 courses; Staphylococcus epidermidis, in 5; and Escherichia coli, in 2. Two patients died; three developed suppurative thrombophlebitis; one developed septic arthritis; one, septic arterial aneurysm; and one, peritonitis with probable meningitis. Colonization with S. aureus increased the risk of S. aureus bacteremia 6.3-fold (95% CI, 2.8 to 14.5; P less than 0.001); skin desquamation at the catheter site increased the relative risk 2.0-fold (95% CI, 1.3 to 3.1; P = 0.031). Both colonization with S. aureus and skin desquamation increased the relative risk of S. aureus bacteremia 14.5-fold (95% CI, 4.1 to 50.9; P less than 0.0001).
CONCLUSIONS: Staphylococcal bacteremia is more frequent in patients receiving interleukin-2 therapy and is associated with substantial morbidity and toxic skin reactions.
Предметные рубрики MeSH
AdultCatheterization, PeripheralCatheters, IndwellingCross InfectionData Interpretation, StatisticalEscherichia coli InfectionsFemaleHumansInterleukin-2Killer Cells, Lymphokine-ActivatedMaleMiddle AgedNeoplasmsProspective StudiesRisk FactorsSepsisSkinStaphylococcal InfectionsStaphylococcus aureusStaphylococcus epidermidis