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Nosocomial Sepsis Associated with Interleukin-2

David R. Snydman, MD; Bernadette Sullivan, RN; Maura Gill, RN; Jody A. Gould, RN; David R. Parkinson, MD; and Michael B. Atkins, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by General Clinical Research Center Grant CRR-00088 and contract N01-CM-73706 from the National Institutes of Health.

Presented in part on October 1988 at the Twenty-Ninth Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, California.

Requests for Reprints: David R. Snydman, MD, Box 238, New England Medical Center, 750 Washington Street, Boston, MA 02111.

Current Author Addresses: Drs. Snydman and Atkins, and Ms. Sullivan, Gill, and Gould: New England Medical Center, 750 Washington Street, Boston, MA 02111.

Dr. Parkinson: M.D. Anderson Hospital, 1515 Holcombe Boulevard, Houston, TX 77030.

©1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(2):102-107. doi:10.7326/0003-4819-112-2-102
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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.





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