David R. Snydman, MD; Bernadette Sullivan, RN; Maura Gill, RN; Jody A. Gould, RN; David R. Parkinson, MD; Michael B. Atkins, MD
Study Objective: To determine the incidence, clinical magnitude, and risk factors for nosocomial bacteremia in patients given interleukin-2 with or without (±) lymphokine activated killer (LAK) cells for cancer immunotherapy.
Design: Cohort study.
Setting: Clinical study unit of tertiary medical center.
Patients: All patients entering the interleukin-2 ±LAK cancer immunotherapy protocol during a 28-month period. Control groups were patients in a surgical intensive care unit, patients receiving total parenteral nutrition, and patients with solid tumors.
Measurements and Main Results: Twenty of 107 (19%) interleukin-2-treated patients developed sepsis; in 12 of these patients, sepsis was intravenous catheter-associated. The bacteremia rate among patients receiving total parenteral nutrition, in the surgical intensive care unit, or having solid tumors was 2.8%, 4.1%, and 1.9%, respectively. Staphylococcus aureus was the pathogen in 13 courses; Staphylococcus epidermidis, in 5; and Escherichia coli, in 2. Two patients died; three developed suppurative thrombophlebitis; one developed septic arthritis; one, septic arterial aneurysm; and one, peritonitis with probable meningitis. Colonization with S. aureus increased the risk of S. aureus bacteremia 6.3-fold (95% CI, 2.8 to 14.5; P < 0.001); skin desquamation at the catheter site increased the relative risk 2.0-fold (95% CI, 1.3 to 3.1; P = 0.031). Both colonization with S. aureus and skin desquamation increased the relative risk of S. aureus bacteremia 14.5-fold (95% CI, 4.1 to 50.9; P < 0.0001).
Conclusions: Staphylococcal bacteremia is more frequent in patients receiving interleukin-2 therapy and is associated with substantial morbidity and toxic skin reactions.
David R. Snydman, Bernadette Sullivan, Maura Gill, Jody A. Gould, David R. Parkinson, Michael B. Atkins. Nosocomial Sepsis Associated with Interleukin-2. Ann Intern Med. 1990;112:102–107. doi: 10.7326/0003-4819-112-2-102
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Published: Ann Intern Med. 1990;112(2):102-107.
Infectious Disease, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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