Septic endarteritis due to intra-arterial catheters for cancer chemotherapy. I. Evaluation of an outbreak. II. Risk factors, clinical features and management, III. Guidelines for prevention

A cluster of three cases of staphylococcal septic endarteritis originating from percutaneously inserted brachial artery catheters for regional cancer chemotherapy prompted an epidemiologic and clinical study of bacteremic infections associated with this therapeutic modality. Nine cases were identified over a 3 1/2-year period (1.6% of all catheterizations), all caused by Staphylococcus aureus. The cluster followed discontinuation of hexachlorophene for scrub of the extremity prior to cannulation; phage-typing suggested the three cases were caused by the patients' own strains of Staphylococcus. These infections produced a distinctive clinical syndrome which facilitates implicating the catheter in the genesis of fever occurring in a patient receiving intra-arterial chemotherapy: early localized pain (89%) and hemorrhage (78%), and Osler's nodes distally (44%), later followed by local inflammation (78%), purulence (56%) and signs of systemic sepsis (100%) (each factor, p less than or equal to .005). Duration of cannulation did not influence susceptibility to infection. However, difficult cannulations or need for repositioning the catheter (p = .0096), prior radiation therapy (p = .033), leukopenia (p less than .05) and hypoalbuminemia (p less than .05) were all associated with septicemia. In the 25 months since implementation of specific control measures, there have been no further catheter-related septicemia in 310 catheterization (p less than .001). Guide-lines for prevention and management of these infections are provided.

[Prognostic importance of lymphocytosis in obliterating endarteritis]

Based on observations of 317 patients with obliterating endarteritis, the most persistant effect following the complex therapy was noted in patients showing lymphocytosis after the treatment. The overwhelming majority of patients with unfavourable issues of the therapy showed lymphopenia. So, of 67 patients showing lymphocytosis after 2--3 courses of the therapy 48 patients proved to be practically recovered. But there was no recovery among 30 lymphopenic patients, and in 13 cases the extremity had to be amputated. Among 220 patients showing the normal amount of lymphocytes the repeat course of the therapy resulted in a complete recovery in 19, in 2 cases the extremity was amputated.