PERMANENT CENTRAL VENOUS ACCESS IN AIDS P ATIENTS - A HELPFUL DEVICE FOR HOMECARE OR AN UNACCEPTABLY HIGH INFECTION RISK

Aim of the prospective study was to evaluate the infection risk of por t-a-Cath-systems in AIDS patients and the prognosis of these catheter related complications. Over a 5-year period (December 1989 through Nov ember 1994) 50 port-a-Cath-systems were implanted in 44 AIDS patients. 77.2% of the patients were homosexuals, 20.5% were iv drug abusers. I n 68% the indication for implantation of the catheter was prophylactic parenteral treatment in CMV retinitis. The mean duration of catheter use was 131.5 +/- 100.4 days (range = 7-421 days). 20 (40%) catheter-r elated infections occurred, thus implying an infection rate of 0.3 inf ections per 100 catheter days without difference between the risk grou ps of patients. Homecare was associated with an infection rate of 0.26 infections/100 catheter days compared with 1.0 infections/100 cathete r days in in-patients. The most frequent causative organisms (75% of t he infections) were staphylococci (40% Staphylococcus epidermidis). 19 /20 infected catheters had to be removed after treating the patients b y antimicrobial agents for a mean of 9.63 +/- 1.92 days. In 5/19 cases the germ was eradicated for a short period of time, but in every case bacteremia relapsed and the catheter had to be explanted. In one pati ent antimicrobial chemotherapy alone was successful. 30 patients died, 4 (13.3%) due to generalized bacterial infection. Based on these resu lts, port-a-Cath-systems are helpful and safe devices for patient-cent ered and cost effective care of-AIDS patients at home.