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Coagulase-Negative Staphylococcal Bacteremia in Patients Receiving Immunosuppressive Therapy

Coagulase-Negative Staphylococcal Bacteremia in Patients Receiving Immunosuppressive Therapy Abstract • From January 1977 to June 1980, coagulase-negative staphylococci caused bacteremia in 22 (17%) of 130 patients receiving immunosuppressive therapy and were the most common cause of all bacteremias. Sixteen (73%) of the 22 patients had granulocytopenia, and eight were isolated in a laminar air-flow room. A Broviac or Hickman central intravenous (IV) catheter was present in 20 (91%) of 22 patients, and soft-tissue inflammation at the catheter exit site was a significant risk factor for bacteremia. Except for debilitating fevers and local mucocutaneous infections, there were no distinguishing clinical features in patients with bacteremia. Most infections responded to cefazolin sodium or vancomycin hydrochloride therapy; catheter removal was necessary in only seven patients. These data show that coagulase-negative staphylococci can be important pathogens in patients receiving immunosuppressive therapy, even when the patients are isolated in a laminar air-flow room, if normal mucocutaneous, host-defense barriers are interrupted by IV catheter-insertion or chemotherapy. (Arch Intern Med 1983;143:32-36) References 1. Levine AS, Schimpff SC, Graw RG, et al: Hematologic malignancies and other marrow failure states: Progress in the management of complicating infections. Semin Hematol 1974;11:141-202. 2. Pizzo PA: Infectious complications in the child with cancer: I. Pathophysiology of the compromised host and the initial evaluation and management of the febrile cancer patient. J Pediatr 1981;98:341-354.Crossref 3. Sotman SB, Schimpff SC, Young VM: Staphylococcus aureus bacteremia in patients with acute leukemia. Am J Med 1980;69:814-818.Crossref 4. Ladisch S, Pizzo PA: Staphylococcus aureus sepsis in children with cancer. Pediatrics 1978;61:231-234. 5. Pizzo PA, Ladisch S, Simon RM, et al: Increasing incidence of gram-positive sepsis in cancer patients. Med Pediatr Oncol 1978;5:241-244.Crossref 6. Kilton LJ, Fossieck BE, Cohen MH, et al: Bacteremia due to gram-positive cocci in patients with neoplastic disease. Am J Med 1979;66:596-602.Crossref 7. Winston DJ, Gale RP, Meyer DV, et al: Infectious complications of human bone marrow transplantation. Medicine 1979;58:1-31.Crossref 8. Meyer DV, Winston DJ, Young LS, et al: Surveillance cultures in immunosuppressed patients: What do they mean? in Nelson JD, Grassi C (eds): Current Chemotherapy and Infectious Disease . Washington, DC, The American Society for Microbiology, 1980, pp 1436-1437. 9. UCLA Bone Marrow Transplant Team: Bone marrow transplantation in acute leukemia. Lancet 1977;2:1197-1200. 10. Gale RP, Ho W, Feig S, et al: Prevention of graft rejection following bone marrow transplantation. Blood 1981;57:9-12. 11. Douer D, Champlin RE, Ho WG, et al: High-dose combined-modality therapy and autologous bone marrow transplantation in resistant cancer. Am J Med 1981;71:973-976.Crossref 12. Gale RP, Cline MJ: High remission-induction rate in acute myeloid leukemia. Lancet 1977;1:497-499.Crossref 13. Pizzo PA: The value of protective isolation in preventing nosocomial infections in high-risk patients. Am J Med 1981;70:631-637.Crossref 14. Lau WK, Young LS, Black RE, et al: Comparative efficacy and toxicity of amikacin/carbenicillin versus gentamicin/carbenicillin in leukopenic patients. Am J Med 1977;62:212-219.Crossref 15. Broviac JW, Cole JJ, Scribner BH: A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973;136:602-606. 16. Hickman RO, Buckner CD, Clift RA, et al: A modified right atrial catheter for access to the venous system in marrow recipients. Surg Gynecol Obstet 1979;148:871-875. 17. Kloss WE, Smith PB: Staphylococci , in Lennette EH, Balows A, Hausler WJ, et al (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, The American Society for Microbiology, 1980, pp 83-87. 18. Washington JA, Sutter VL: Dilution susceptibility test: Agar and macrobroth dilution procedures , in Lennette EH, Balows A, Hausler WJ (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, The American Society for Microbiology, 1980, pp 453-458. 19. Dixon WJ: BMDP Biomedical Computer Program P-Series . Berkeley, Ca, University of California Press, 1977. 20. Andriole VT, Lyons RW: Coagulase-negative staphylococcus. Ann NY Acad Sci 1970;174:533-544.Crossref 21. Coagulase-negative staphylococci. Lancet 1981;1:139-140. 22. Forse RA, Dixon C, Bernard K, et al: Staphylococcus epidermidis: An important pathogen. Surgery 1979;86:507-514. 23. Stiges-Serra A, Puig P, Jaurrieta E, et al: Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition. Surg Gynecol Obstet 1980;151:481-483. 24. Wade JC, Schimpff SC, Newman KA, et al: Staphylococcus epidermidis: An increasingly significant pathogen in granulocytopenic leukemia patients, abstracted. Clin Res 1980;28:381A. 25. Schimpff SC, Greene WH, Young VM, et al: Infection prevention in acute nonlymphocytic leukemia: Laminar air-flow room reverse isolation with oral, nonabsorbable antibiotic prophylaxis. Ann Intern Med 1975;82: 351-358.Crossref 26. Plaut ME, Palaszynski F, Bjornsson S, et al: Staphylococcus bacteremia in a `germ-free' unit. Arch Intern Med 1976;136:1238-1240.Crossref 27. Wise RI: Modern management of severe staphylococcal disease. Medicine 1973;52:295-304.Crossref 28. Archer GL: Antimicrobial susceptibility and selection of resistance among Staphylococcus epidermidis isolates recovered from patients with infections of indwelling foreign devices. Antimicrob Agents Chemother 1978;14:353-359.Crossref 29. Bender JW, Hughes WT: Fatal Staphylococcus epidermidis sepsis following bone marrow transplantation. Johns Hopkins Med J 1980;140:13-15. 30. Murphy MT, Campbell BJ, March J, et al: Characteristics of coagulase-negative staphylococci isolated from marrow transplant patients. Read before the 81st annual meeting of the American Society for Microbiology, Dallas, March 1, 1981. 31. Siebert WT, Moreland N, Williams TW: Synergy of vancomycin plus cefazolin or cephalothin against methicillin-resistant Staphylococcus epidermidis. J Infec Dis 1979;139:452-457.Crossref 32. Archer GL, Tenenbaum MJ, Haywood RB: Rifampin therapy of Staphylococcus epidermidis. JAMA 1978;240:751-753.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Coagulase-Negative Staphylococcal Bacteremia in Patients Receiving Immunosuppressive Therapy

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350010034007
Publisher site
See Article on Publisher Site

Abstract

Abstract • From January 1977 to June 1980, coagulase-negative staphylococci caused bacteremia in 22 (17%) of 130 patients receiving immunosuppressive therapy and were the most common cause of all bacteremias. Sixteen (73%) of the 22 patients had granulocytopenia, and eight were isolated in a laminar air-flow room. A Broviac or Hickman central intravenous (IV) catheter was present in 20 (91%) of 22 patients, and soft-tissue inflammation at the catheter exit site was a significant risk factor for bacteremia. Except for debilitating fevers and local mucocutaneous infections, there were no distinguishing clinical features in patients with bacteremia. Most infections responded to cefazolin sodium or vancomycin hydrochloride therapy; catheter removal was necessary in only seven patients. These data show that coagulase-negative staphylococci can be important pathogens in patients receiving immunosuppressive therapy, even when the patients are isolated in a laminar air-flow room, if normal mucocutaneous, host-defense barriers are interrupted by IV catheter-insertion or chemotherapy. (Arch Intern Med 1983;143:32-36) References 1. Levine AS, Schimpff SC, Graw RG, et al: Hematologic malignancies and other marrow failure states: Progress in the management of complicating infections. Semin Hematol 1974;11:141-202. 2. Pizzo PA: Infectious complications in the child with cancer: I. Pathophysiology of the compromised host and the initial evaluation and management of the febrile cancer patient. J Pediatr 1981;98:341-354.Crossref 3. Sotman SB, Schimpff SC, Young VM: Staphylococcus aureus bacteremia in patients with acute leukemia. Am J Med 1980;69:814-818.Crossref 4. Ladisch S, Pizzo PA: Staphylococcus aureus sepsis in children with cancer. Pediatrics 1978;61:231-234. 5. Pizzo PA, Ladisch S, Simon RM, et al: Increasing incidence of gram-positive sepsis in cancer patients. Med Pediatr Oncol 1978;5:241-244.Crossref 6. Kilton LJ, Fossieck BE, Cohen MH, et al: Bacteremia due to gram-positive cocci in patients with neoplastic disease. Am J Med 1979;66:596-602.Crossref 7. Winston DJ, Gale RP, Meyer DV, et al: Infectious complications of human bone marrow transplantation. Medicine 1979;58:1-31.Crossref 8. Meyer DV, Winston DJ, Young LS, et al: Surveillance cultures in immunosuppressed patients: What do they mean? in Nelson JD, Grassi C (eds): Current Chemotherapy and Infectious Disease . Washington, DC, The American Society for Microbiology, 1980, pp 1436-1437. 9. UCLA Bone Marrow Transplant Team: Bone marrow transplantation in acute leukemia. Lancet 1977;2:1197-1200. 10. Gale RP, Ho W, Feig S, et al: Prevention of graft rejection following bone marrow transplantation. Blood 1981;57:9-12. 11. Douer D, Champlin RE, Ho WG, et al: High-dose combined-modality therapy and autologous bone marrow transplantation in resistant cancer. Am J Med 1981;71:973-976.Crossref 12. Gale RP, Cline MJ: High remission-induction rate in acute myeloid leukemia. Lancet 1977;1:497-499.Crossref 13. Pizzo PA: The value of protective isolation in preventing nosocomial infections in high-risk patients. Am J Med 1981;70:631-637.Crossref 14. Lau WK, Young LS, Black RE, et al: Comparative efficacy and toxicity of amikacin/carbenicillin versus gentamicin/carbenicillin in leukopenic patients. Am J Med 1977;62:212-219.Crossref 15. Broviac JW, Cole JJ, Scribner BH: A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973;136:602-606. 16. Hickman RO, Buckner CD, Clift RA, et al: A modified right atrial catheter for access to the venous system in marrow recipients. Surg Gynecol Obstet 1979;148:871-875. 17. Kloss WE, Smith PB: Staphylococci , in Lennette EH, Balows A, Hausler WJ, et al (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, The American Society for Microbiology, 1980, pp 83-87. 18. Washington JA, Sutter VL: Dilution susceptibility test: Agar and macrobroth dilution procedures , in Lennette EH, Balows A, Hausler WJ (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, The American Society for Microbiology, 1980, pp 453-458. 19. Dixon WJ: BMDP Biomedical Computer Program P-Series . Berkeley, Ca, University of California Press, 1977. 20. Andriole VT, Lyons RW: Coagulase-negative staphylococcus. Ann NY Acad Sci 1970;174:533-544.Crossref 21. Coagulase-negative staphylococci. Lancet 1981;1:139-140. 22. Forse RA, Dixon C, Bernard K, et al: Staphylococcus epidermidis: An important pathogen. Surgery 1979;86:507-514. 23. Stiges-Serra A, Puig P, Jaurrieta E, et al: Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition. Surg Gynecol Obstet 1980;151:481-483. 24. Wade JC, Schimpff SC, Newman KA, et al: Staphylococcus epidermidis: An increasingly significant pathogen in granulocytopenic leukemia patients, abstracted. Clin Res 1980;28:381A. 25. Schimpff SC, Greene WH, Young VM, et al: Infection prevention in acute nonlymphocytic leukemia: Laminar air-flow room reverse isolation with oral, nonabsorbable antibiotic prophylaxis. Ann Intern Med 1975;82: 351-358.Crossref 26. Plaut ME, Palaszynski F, Bjornsson S, et al: Staphylococcus bacteremia in a `germ-free' unit. Arch Intern Med 1976;136:1238-1240.Crossref 27. Wise RI: Modern management of severe staphylococcal disease. Medicine 1973;52:295-304.Crossref 28. Archer GL: Antimicrobial susceptibility and selection of resistance among Staphylococcus epidermidis isolates recovered from patients with infections of indwelling foreign devices. Antimicrob Agents Chemother 1978;14:353-359.Crossref 29. Bender JW, Hughes WT: Fatal Staphylococcus epidermidis sepsis following bone marrow transplantation. Johns Hopkins Med J 1980;140:13-15. 30. Murphy MT, Campbell BJ, March J, et al: Characteristics of coagulase-negative staphylococci isolated from marrow transplant patients. Read before the 81st annual meeting of the American Society for Microbiology, Dallas, March 1, 1981. 31. Siebert WT, Moreland N, Williams TW: Synergy of vancomycin plus cefazolin or cephalothin against methicillin-resistant Staphylococcus epidermidis. J Infec Dis 1979;139:452-457.Crossref 32. Archer GL, Tenenbaum MJ, Haywood RB: Rifampin therapy of Staphylococcus epidermidis. JAMA 1978;240:751-753.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1983

References