NOSOCOMIAL COAGULASE-NEGATIVE STAPHYLOCOCCAL INFECTIONS IN BONE-MARROW TRANSPLANTATION RECIPIENTS WITH CENTRAL VEIN CATHETER - A 5-YEAR PROSPECTIVE STUDY

The purpose of this study was to examine coagulase-negative staphyloco ccal infections in bone marrow transplantation (BMT) patients with cen tral vein catheters by investigating incidence, clinical relevance, ri sk factors, methicillin resistance, clinical impact of initial empiric antimicrobial therapy without vancomycin, and management of documente d catheter-related infections, A 5-year prospective study was conducte d with daily evaluation of 242 BMT patients during hospitalization, in cluding clinical assessment and blood culture via the Hickman/Broviac catheter, If fewer or infected appearance occurred, peripheral blood c ultures or exit site cultures, respectively, were done. Results showed a septicemia incidence of 7.0%, including in 6 patients following col onization, in 1 patient with tunnel infection, in 1 patient with throm bophlebitis, in 1 patient with exit site infection, and in 8 patients with septicemia of unknown origin. Total colonization incidence was 7% , with colonization only in 11 patients who had 16 episodes; incidence of exit site infection was 3.7%. Age greater than or equal to 18 year s was the only identified risk factor for developing staphylococcal in fection (P=0.03). Despite a methicillin resistance rate of 45% and omi ssion of vancomycin from the routine initial empiric antimicrobial reg imen, the clinical course of coagulase-negative staphylococcal infecti ons was relatively benign. A single patient, who experienced marrow re jection, died on day +31 with septicemia and only one patient experien ced microbiological failure with recurrent colonization. Bacteria grow n in both aerobic and anaerobic bottles were more likely true bacterem ia than contaminant (P=0.03). We conclude that the hazard of coagulase -negative staphylococcal infection does not mandate inclusion of a gly copeptide in the initial empiric antimicrobial regimen in BMT patients , even during febrile neutropenia. Hickman/Broviac-related staphylococ cal infections, except for tunnel infection or thrombophlebitis, can u sually be treated successfully without removing the catheter.