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PubMedDate not supplied

Management of mandibular fascial space infection of odontogenic origin.

Cellulitis is an acute, painful infection whose swelling is larger with diffuse borders. When palpated, early cellulitis can be very soft or doughfy; a severe cellulitis is almost always described as indurated or even as being "board-like". It can be innocuous in its early stages and extremely dangerous in its more advance, indurated, rapidly spreading stages. Randy, a 16 years old boy who thought that a regularly occurring toothache can advance into a life-threatening complication has a lot to be thankful for. The patient was referred to the Pediatric Dentistry Division by the E.R. doctors for further evaluation and management due to a swelling on the lower quadrant of his face. This was on the 8th day after he experienced the first pain on tooth no. 47.

Adolescent↗
PubMed1975

Differential diagnosis and treatment of gas-producing infections.

During an 8-year period, 30 patients with gas-producing infections were admitted for treatment of hyperbaric oxygen. Infection was a consequence of trauma and operation in 26 cases and a complication of other diseases in 4 cases. The definitive diagnoses were clostridial myositis in 12 cases, clostridial cellulitis in 7, non-clostridial cellulitis in 9 (mainly E. coli infections); in 2 cases the diagnoses were uncertain. Six cases of E. coli infection were misinterpreted as myositis and were treated with hyperbaric oxygen at 3 atm. abs. without effect. Five of these cases were cured by antibiotic therapy and surgical drainage. The risk of hyperbaric oxygen at 3 atm. abs. necessitates a strong indication for this kind of treatment. Thirteen cases of clostridial infections (2 with cellulitis, 11 with myositis) were successfully treated with hyperbaric oxygen except in 2 cases of myositis. Helpful data for the plausible diagnosis clostridial myositis in the acute stage were: a typical clinical picture with rapid progress of the local necrosis and inflammatory reaction, roentgenographically demonstrable intramuscular gas, and abundance of gram-positive rods in exudate from the inflammation. Laboratory data had a limited value. In some cases of clostridial myositis, a fall of hemoglobin to low values (less than 7.5 g%) was seen in the first 24 hours and high values of hemoglobin/plasma were noted in 4 cases. Incidents of side-effects from hyperbaric oxygen treatment were frequent but only a few were serious and these subsided during a short interruption of the treatment.

Adolescent↗
PubMed2001

Skin and soft tissues. Management of four common infections in the nursing home patient.

Common skin and soft tissue infections in nursing home patients include herpes zoster, cellulitis, pressure ulcer infections, and scables. Treatment of shingles with an oral antiviral should be started within 24 hours of symptom onset. Dissemination and bacterial superinfection require antibiotic therapy. Use of corticosteroids to prevent post-herpetic neuralgia remains controversial. Cellulitis is most often caused by Staphylococcus aureus and beta-hemolytic streptococci (groups A and B). Therapy for cellulitis is empiric; gram-negative bacilli should be covered in diabetic patients. Most pressure ulcers never become infected; for those that do, empiric therapy should cover S aureus, gram-negative bacilli, and anaerobes. Topical treatment of scables with 5% permethrin cream or 1% lindane lotion is recommended.

Adult↗
PubMed2002

Common bacterial skin infections.

Family physicians frequently treat bacterial skin infections in the office and in the hospital. Common skin infections include cellulitis, erysipelas, impetigo, folliculitis, and furuncles and carbuncles. Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species. Erysipelas is a superficial form of cellulitis with sharply demarcated borders and is caused almost exclusively by Streptococcus. Impetigo is also caused by Streptococcus or Staphylococcus and can lead to lifting of the stratum corneum resulting in the commonly seen bullous effect. Folliculitis is an inflammation of the hair follicles. When the infection is bacterial rather than mechanical in nature, it is most commonly caused by Staphylococcus. If the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle stages and usually requires incision and drainage. All of these infections are typically diagnosed by clinical presentation and treated empirically. If antibiotics are required, one that is active against gram-positive organisms such as penicillinase-resistant penicillins, cephalosporins, macrolides, or fluoroquinolones should be chosen. Children, patients who have diabetes, or patients who have immunodeficiencies are more susceptible to gram-negative infections and may require treatment with a second- or third-generation cephalosporin.

Cellulitis↗
PubMed1987

Outpatient treatment of serious community-acquired pediatric infections using once daily intramuscular ceftriaxone.

Pediatric patients with serious infections are usually hospitalized for parenteral antibiotic treatment. We studied prospectively 74 pediatric patients with community-acquired serious infections and used once daily intramuscular ceftriaxone. Seventeen patients (23%) were initially hospitalized and 57 (77%) patients were treated entirely as outpatients. An initial intramuscular dose of 75 mg/kg was followed by daily doses of 50 mg/kg (maximum, 1.5 g). Infections treated included periorbital/buccal cellulitis, other cellulitis, urinary tract infections, pneumonia, osteomyelitis, mastoiditis, suppurative arthritis and orbital cellulitis. Organisms were recovered from cultures of 37 (50%) patients and 6 (8%) patients were bacteremic. Bacteria included Gram-positive (mostly Staphylococcus aureus) and Gram-negative (mostly enteric bacilli and Haemophilus influenzae organisms). No serious side effects were observed. Of 74 patients 72 (97%) were cured and improvement was usually observed within 24 hours. Two patients did not improve: one with chronic Pseudomonas mastoiditis; and one with lung abscess. Based on previous experience it is estimated that 376 hospitalization days were saved. All 72 successfully treated patients and their parents resumed normal activity within 72 hours of starting therapy. Our data suggest that ceftriaxone can be used for outpatient treatment of some infectious diseases.

Adolescent↗
PubMed1995

Severe necrotizing soft-tissue infections: report of 22 cases.

Twenty-two cases of severe necrotizing soft-tissue infections (SNSTIs), seen by the infectious disease service from 1983 to 1988 in a community teaching hospital, are described and compared with previously reported series. Clinical findings were distinguishable from cellulitis at the time of surgery in only 45% of the patients who had either necrosis, crepitus, vesicle or bullae, and/or an abnormal air pattern on x-ray studies. Patients with "cellulitis" were not less sick than patients with "necrosis" findings (ie, presence of shock, leukocytosis with left shift, fever, or anion gap). Despite the fact that all but one of the patients were seen by the infectious disease service preoperatively, and 55% underwent surgical intervention within 48 hours of admission, patient mortality (18%) was not better than some reported in earlier series. However, the epidemiology of SNSTI was different: in our series there were more diabetic patients (64%) and fewer postsurgical infections (14%). Among the diabetic patients, SNSTI developed more frequently at a site not related to peripheral vasculopathy or neuropathy. Abdominal wall involvement was 10 times more likely be diagnosed as cellulitis (5/8 vs 2/14 with involvement elsewhere, P < 0.02).

Adult↗
PubMed1994

[Necrotizing soft-tissue infections of the extremities].

The term "Necrotizing soft tissue infections" describes a group of limb- and sometimes lifethreatening infections mostly of the limbs. The necrotizing soft tissue infections are classified, depending on the involved tissue level, microbiology and clinical course: 1. primarily located in the subcutaneous level and fascia: 1.1 hemolytic streptococcal gangrene, 1.2 necrotizing fasciitis, 1.3 gram-negative, synergistic, necrotizing cellulitis, 1.4 clostridial cellulitis, 1.5 anaerobic nonclostridial-cellulitis; 2. primary located in the muscle: 2.1 clostridial myonecrosis, 2.2 streptococcal myositis. Between 1989 and 1992 17 patients with necrotizing soft tissue infections were treated at the Department of Surgery, University Hospital of Zurich. Incipient necrotizing soft tissue infections are underestimated easily due to atypical or minor initial signs. The infections may be caused by a variety of bacteria, spread rapidly and can lead to a critical condition. The surgical treatment has to be aggressive with extensive debridement of the affected areas supported by intensive care. Delayed or even omitted surgical treatment, inappropriate therapeutic concepts and incomplete debridement with compromises may have fatal consequences. Repeated debridement as well as amputation of the affected limb is justified to guarantee the patient's survival.

Adult↗
PubMed1994

[Necrotizing soft tissue infection of the extremities].

The term "necrotizing soft tissue infections" describes a group of limb and life-threatening infections. Depending on the tissue level, microbiology and clinical course the necrotizing soft-tissue infections are classified in primary located infections to the subcutaneous level and fascia--like hemolytic streptococcus gangrene, necrotizing fasciitis, gram-negative synergistic necrotizing cellulitis, clostridium-cellulitis, anaerobic non-clostridium-cellulitis and in primary located infections to the muscle--like clostridium myonecrosis and streptococcal myositis. Between 1989 and 1992, 17 patients with necrotizing soft-tissue infections were treated at the Department of Surgery, University Hospital of Zurich. These infections originated from small traumatic injuries or operative wounds ("neglected wounds"). 11 patients suffered from debilitating diseases like diabetes mellitus, drug or alcohol abuse or were compromised by tumors. The average age was 42 years (21-84 years). Following bacteria were found: Staphylococcus aureus, hemolytic Streptococcus, Enterococcus, E. coli, Streptococcus milleri. 2 patients had a mixed infection with more than 3 different bacteria, 6 patients with 2, and 9 patients had a monoinfection. In 14 patients the infection was on the subcutaneous and fascia level, 3 patients showed a myositis or myonecrosis. No patient died, amputation of the limb was necessary in 4 cases. The average hospitalisation was 41 days (13-137 days) whereas 10 patients required between 4 and 53 days intensive care (average 18.3 days). Necrotizing soft-tissue infections are severe illnesses which are underestimated in the primary phase due to atypical or minor primary signs. The infections can be caused by a variety of bacteria and are spreading rapidly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Wells' syndrome: a pathogenic role for circulating CD4+CD7- T cells expressing interleukin-5 mRNA.

Wells' syndrome, or eosinophilic cellulitis, is a rare dermatosis characterized histologically by a dermal infiltrate of eosinophils, lymphocytes and histiocytes between collagen bundles and amorphous or granular eosinophilic deposits on collagen, constituting flame figures. We report a 54-year-old woman with eosinophilic cellulitis whose peripheral blood showed a marked eosinophilia and a high proportion of CD4+CD7- cells before treatment. Reverse transcriptase-polymerase chain reaction revealed that CD4+CD7- cells, but neither CD4+CD7+ nor CD4-CD8+ cells, in the circulating mononuclear cells expressed mRNA for interleukin (IL)-5, the major cytokine involved in eosinophilia. The proportion of CD4+CD7- cells decreased, and expression of mRNA for IL-5 disappeared in the peripheral blood, when the disease was treated by the administration of intravenous recombinant interferon-gamma. These findings suggest that circulating CD4+CD7- T cells play a pivotal role in the pathogenesis of eosinophilic cellulitis by producing IL-5.

Antigens, CD7↗
PubMed1997

Skin blood flow of the lymphedematous arm before and after liposuction.

Twelve women with arm lymphedema after breast cancer treatment underwent liposuction followed by external compression with a garment-sleeve. Arm volumes were measured using water displacement technique, and skin blood flow was recorded with laser Doppler imaging (LDI). Data was collected before and after (3 and 12 months) liposuction. Episodes of cellulitis were also recorded. Whereas previous investigations have indicated increased total blood flow in the lymphedematous arm, we found reduced superficial skin blood flow preoperatively. Liposuction produced a median edema reduction of 87% and 97% after 3 and 12 months respectively. Both in the forearm and in the upper arm, skin blood flow increased significantly after liposuction and values were similar to those of the non-edematous (control) arm. Along with increased skin blood flow, the frequency of cellulitis also decreased. Liposuction effectively reduces arm lymphedema after breast cancer treatment, and also lowers the incidence of arm cellulitis. Improved local skin blood flow may be an important contributing factor to the reduced episodes of arm infection.

Aged↗
PubMed2003

Infections in children with nephrotic syndrome.

OBJECTIVE: To determine the different types of infections in nephrotic children and their association with the activity of disease. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: It was carried out at National Institute of Child Health (NICH), Karachi from August 1995-July 1996. PATIENTS AND METHODS: All children with nephrotic syndrome who had various infections during the study period were evaluated for the activity of disease and type of infections. RESULTS: Out of 62 children with nephrotic syndrome having infections, 45 (72.58%) were boys and 17 (27.42%) girls in a ratio of 2.5:1. Out of them 53 (85.45%) were known nephrotics and 36 (58%) of them were on steroid therapy. Nine were new cases and had not received steroids. A total of 74 episodes of infections were observed in 62 children. Acute respiratory infections (ARI) and skin infections were the most common (29.27% and 27.02% respectively) followed by diarrhoea (13.51%), UTI (12.5%) and peritonitis (10.81%). Two patients had pulmonary tuberculosis and 3 patients had more than one infection (cellulitis, peritonitis and pneumonia). All children with cellulitis and peritonitis were in active disease, whereas more than 80% of patients with ARI, diarrhoea and UTI were having either relapse or had recent onset of disease. CONCLUSION: The study showed that ARI, cellulitis and diarrhoea were most common infections followed by UTI and peritonitis. Majority of the infections (>78%) were associated with active disease

Child↗
PubMed1999

Major bleeding after hospitalization for deep-venous thrombosis.

PURPOSE: Most studies of oral anticoagulant-related bleeding have analyzed the incidence of adverse outcomes among patients with a variety of different conditions and without any comparison with a control group. We determined the incidence, time course, and risk factors associated with major bleeding after hospital discharge among patients with deep-vein thrombosis, and estimated the excess risk of bleeding associated with oral anticoagulant therapy. METHODS: A total of 22,000 adults were hospitalized in California for 3 or more days with a diagnosis of deep-venous thrombosis between January 1, 1992, and September 30, 1994. We determined the risk factors associated with readmission for bleeding. We compared the incidence of readmission for bleeding with comparison cohorts of patients with pneumonia or cellulitis who were matched for age, gender, race, and length of hospital stay. RESULTS: Of 21,250 patients with deep-venous thrombosis who were discharged without bleeding, 1.4% were readmitted for bleeding within 91 days; the rate was 2.7 times greater in the first 30 days than in the next 61 days. Risk factors for bleeding included hospitalization with gastrointestinal bleeding during the previous 18 months (relative hazard [RH] = 2.6, 95% confidence interval [CI]: 1.6 to 4.1), hospitalization with an alcohol-related diagnosis during the previous 18 months (RH = 2.6, 95% CI: 1.4 to 4.8), chronic renal disease (RH = 2.4, 95% CI: 1.4 to 4.2), female gender (RH = 1.7, 95% CI: 1.3 to 2.2), presence of a malignancy (RH = 1.6, 95% CI: 1.2 to 2.2), nonwhite race (RH = 1.6, 95% CI: 1.2 to 2.1), and age over 65 years (RH = 1.3, 95% CI: 1.0 to 1.7). Significantly more women (n = 40) had intracranial bleeding than men (n = 18, P = 0.02). In the comparison cohorts, the incidence of readmission for bleeding within 3 months of discharge was 0.7%, and the relative risk (RR) of readmission was greater in those with deep-venous thrombosis than in those with cellulitis (RR = 2.0, 95% CI: 1.6 to 2.5) or pneumonia (RR = 2.0, 95% CI: 1.7 to 2.5). CONCLUSIONS: The incidence of rehospitalization for bleeding was greatest in the first 30 days after discharge, and was approximately twice that seen in patients hospitalized for cellulitis or pneumonia. Further studies are needed to determine why women and nonwhite patients are at increased risk for anticoagulant-related bleeding.

Adult↗
PubMed1994

Exogenous endophthalmitis initially treated without systemic antibiotics.

PURPOSE: In 1987, the authors reported the successful eradication of infection in 16 patients with culture-proven acute exogenous bacterial endophthalmitis using intravitreal but no systemic antibiotics. They retrospectively reviewed additional consecutive cases since then to determine if the initial omission of systemic antibiotics remained reasonable. METHODS: Twenty patients had culture-proven endophthalmitis. Four patients initially received systemic antibiotics for orbital cellulitis (2 patients), prevention of a possible scleral buckle infection (1 patient), and ascending cholangitis (1 patient). The remaining 16 patients were treated initially with intravitreal antibiotics only. FINDINGS: Three of these additional 16 patients ultimately required systemic antibiotics for orbital cellulitis (1 patient), infectious scleritis (1 patient), and prevention of central nervous system infection with Neisseria meningitidis (1 patient). Only in one patient who had a neglected endophthalmitis and in whom an orbital cellulitis ultimately developed were we unable to clear the intraocular infection. In the overall series of 32 patients, cultures yielded staphylococcal species in 16 eyes, gram-positive bacilli in 3, streptococcal infection in 5, gram-negative cocci in 1, and gram-negative bacilli in 7. Half of the 14 specimens (1 aqueous and 13 vitreal) collected at the time of 16 reinjections in 13 eyes yielded organisms. Half (16/32) of the eyes attained visual acuity of 20/40 or better; 87.5% (28/32) attained visual acuity of 20/400 or better. CONCLUSIONS: Therapy with intravitreal antibiotics without systemic antibiotics is reasonable, unless the infection has extended (or is at risk to extend) beyond the globe. Such evidence includes an elevated temperature or leukocyte count, corneal ring abscess, proptosis, loss of extraocular movements, scleral abscesses or infectious scleritis, and, perhaps, the presence of a scleral buckle.

Anti-Bacterial Agents↗
PubMed1999

Bullous erysipelas: A retrospective study of 26 patients.

BACKGROUND: Erysipelas is a superficial form of cellulitis caused by a variety of microbes, and it responds to antibiotic treatment. During the past few years we treated several patients with a bullous form of erysipelas involving the lower legs. We believe their disease had a more protracted course than patients with nonbullous erysipelas. OBJECTIVE: We studied bullous erysipelas by conducting a retrospective analysis of 26 patients with bullous erysipelas of the legs treated by the authors during a 5-year period. METHODS: We conducted a retrospective review of the records of all patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, Hadassah Medical Center, Jerusalem, between the years 1992 and 1996. Data regarding patients with nonbullous erysipelas were obtained from the medical center's computerized data pool. RESULTS: A total of 26 cases of bullous erysipelas were found, comprising 22 women and 4 men whose ages ranged from 28 to 87 (mean, 58.8) years. The average hospital stay was 20.57 days (range, 12 to 46 days). The average hospital stay for patients with nonbullous erysipelas and cellulitis treated in the same department by the authors during the study period was 10.6 days (range, 2 to 54 days). CONCLUSION: Bulla formation is a complication of erysipelas, seen in our series in 5.2% of the patients (26 of 498 admissions for erysipelas and cellulitis). The course of the disease is protracted, requiring longer medical attention.

Adult↗
PubMed1997

Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast.

PURPOSE: Although the clinical outcome after treatment of ductal carcinoma in situ (DCIS) using breast-conservation surgery and radiation therapy has been well documented, little data has been reported on cosmetic outcome or treatment complications. Therefore, the present study was performed to evaluate cosmesis and complications after breast-conservation treatment for DCIS and to analyze various factors that might affect cosmesis and predispose to complications. METHODS AND MATERIALS: The records of 90 patients who were alive without evidence of disease with a 3-year minimum follow-up were evaluated for cosmetic results and treatment complications following breast-conservation surgery and radiation therapy for DCIS. Complete gross excision of the primary tumor had been performed in all patients. Additionally, 24 patients had undergone an axillary lymph node dissection in the earlier years of the study. The majority of the patients had received 50-50.4 Gy to the whole breast followed by an electron boost for a total dose of 60-66 Gy. RESULTS: The cosmetic results of 90 evaluable patients at 3 years were: excellent in 69 (77%), good in 19 (21%), and fair in 2 (2%). The cosmetic results of 64 evaluable patients at 5 years were: excellent in 46 (72%), good in 16 (25%), and fair in 2 (3%). Factors associated with worse cosmetic results were an increased volume of tissue excised (>70 cm3) and a negative ipsilateral breast biopsy after radiotherapy. Complications in the 24 patients with an axillary dissection were: arm edema (n = 6), cellulitis of the arm (n = 5), and axillary vein thrombosis (n = 1). Complications in the 66 patients without an axillary dissection were: cellulitis of the arm (n = 1) and cellulitis of the breast (n = 1). DISCUSSION: Breast-conservation surgery followed by radiation therapy achieved excellent or good cosmetic results in 98 and 97% of patients at 3 years and 5 years, respectively. Complications were associated primarily with axillary dissection, which is no longer standard practice, and complications were uncommon in patients without an axillary dissection. Therefore, patients currently treated for DCIS of the breast would be expected to have a high rate of excellent or good cosmetic outcome with a low risk of complications.

Axilla↗
PubMed1999

Treatment-related toxicity from a randomized trial of the sequencing of doxorubicin and radiation therapy in patients treated for early stage breast cancer.

PURPOSE: There is concern that breast cancer patients treated with left-sided radiation therapy (XRT) and doxorubicin (DOX) may have an increased risk of cardiac toxicity. In addition, the effect of different sequencing of XRT and chemotherapy (CT) on the likelihood of cardiotoxicity, as well as cellulitis, arm edema, or brachial plexopathy, is not well understood. We reviewed the records of patients treated on a randomized trial testing the sequencing of CT and XRT to determine if there was an increase in cardiac events or other complications in patients treated with a total dose of DOX of 180 mg/m2 and XRT, comparing patients with treatment to the left breast and the right breast, and comparing patients treated with initial CT and initial RT. MATERIALS AND METHODS: From June 1984 to December 1992, 244 patients with clinical stage I or II breast cancer were randomized following conservative surgery to receive CT (4 cycles of CAMFP at 3 week intervals) either before or after XRT (45 Gy to the entire breast, followed by a boost of 16 Gy; nodal radiation therapy was optional). Two hundred thirty-one patients were evaluable for the development of cardiac toxicity. The median age at diagnosis was 45 years (range, 20-68). CT doses were: doxorubicin, 45 mg/m2 IV bolus, d 3; methotrexate, 200 mg/m2 IV, d 1 and 15; 5-fluorouracil, 500 mg/m2 IV, d 1; cyclophosphamide, 500 mg/m2 IV, d 1; prednisone 40 mg p.o., d 1-5. A cardiac event was defined as a myocardial infarction or clinical evidence of congestive heart failure. Median follow-up time was 53 months. RESULTS: No cardiac events were observed for patients with either left- or right-sided breast cancer. The sequencing of CT and XRT had no significant effect on the risk of cardiac toxicity, cellulitis, arm edema or brachial plexopathy. CONCLUSIONS: We observed no evidence of an increased risk of cardiac toxicity from the addition of left breast tangential irradiation to DOX at a total dose of 180 mg/m2. Additional follow-up is needed to exclude possible late events. In addition, the sequencing of CT and XRT does not appear to affect the risk of cellulitis, arm edema, or brachial plexopathy.

Adult↗
PubMed1989

Eyelid necrosis complicating acute maxillary sinusitis.

Orbital cellulitis is a well recognized complication of paranasal sinusitis. Fearon et al. (1979) reviewed 6,770 cases of sinusitis, of which only 159 had orbital cellulitis. We report a case in which orbital cellulitis progressed to necrosis of the eyelids. This was treated by desloughing and split skin grafting.

Eyelids↗
PubMed1995

The incidence of first Hickman catheter-related infection and predictors of catheter removal in cancer patients.

OBJECTIVE: To describe the incidence and types of first Hickman catheter-related infection (HCRI) in cancer patients and to identify indicators for catheter removal. DESIGN: Retrospective cohort study. SETTING: A regional, tertiary, referral cancer center and its supportive care university teaching hospital. PATIENTS AND METHODS: A retrospective review was conducted of 316 consecutive adult oncology patients who underwent Hickman catheter placement from 1986 to 1990 at a regional oncology center. HCRI was determined on the basis of clinical information incriminating the Hickman catheter as the source of infection. Patient characteristics and data about HCRIs (exit site cellulitis, tunnel infection with concomitant exit site cellulitis, bloodstream infection, and exit site cellulitis with bloodstream infection) were abstracted from patient medical records. Subsequently, univariate and multivariate analyses for the risk of HCRI and catheter removal were completed. RESULTS: The incidence of first HCRI was 5.98 infections per 1,000 catheter days. Overall, 156 (49%) of 316 patients developed their first HCRI prior to catheter removal. The median time to HCRI was 90 days. Male gender (P = .0004) and hematologic malignancy (P = .0001) emerged as significant risk factors for HCRI in the univariate analysis. A cox model verified that male gender (P = .02) and hematologic malignancy (P = .004) were associated with an enhanced risk of HCRI. There were 35 exit site infections (23%), three infections of the tunnel and the exit site (2%), 80 bloodstream infections (51%), and another 38 bloodstream infections with concomitant exist site infections (24%). The incidence of bloodstream infection was 3.05 per 1,000 catheter days. Gram-positive pathogens outnumbered gram-negatives and fungi, with Staphylococcus epidermidis being most common. Fifty (32%) of 156 HCRIs resulted in catheter removal. Predictors of Hickman catheter removal in the univariate analysis were bloodstream infection (P = .046) and pathogen type (P = .006). Multiple regression analysis suggested that having a gram-negative (P = .014) or fungal (P = .057) pathogen was the most important factor for catheter removal. CONCLUSIONS: These data suggest that first HCRIs occur more commonly in male patients with hematologic malignancies than in patients with solid tumors. The removal of Hickman catheters in oncology patients probably is predicated on the causative pathogen, but further investigations are necessary to delineate this issue.

Adult↗