A cluster of three cases of staphylococcal septic
endarteritis originating from percutaneously inserted brachial artery
catheters for regional
cancer chemotherapy prompted an epidemiologic and clinical study of bacteremic
infections associated with this therapeutic modality. Nine cases were identified over a 3 1/2-year period (1.6% of all catheterizations), all caused by Staphylococcus aureus. The cluster followed discontinuation of
hexachlorophene for scrub of the extremity prior to cannulation; phage-typing suggested the three cases were caused by the patients' own strains of Staphylococcus. These
infections produced a distinctive clinical syndrome which facilitates implicating the
catheter in the genesis of
fever occurring in a patient receiving intra-arterial
chemotherapy: early localized
pain (89%) and
hemorrhage (78%), and Osler's nodes distally (44%), later followed by local
inflammation (78%), purulence (56%) and signs of systemic
sepsis (100%) (each factor, p less than or equal to .005). Duration of cannulation did not influence susceptibility to
infection. However, difficult cannulations or need for repositioning the
catheter (p = .0096), prior
radiation therapy (p = .033),
leukopenia (p less than .05) and
hypoalbuminemia (p less than .05) were all associated with
septicemia. In the 25 months since implementation of specific control measures, there have been no further
catheter-related
septicemia in 310 catheterization (p less than .001). Guide-lines for prevention and management of these
infections are provided.