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To: Scott H. Davis who wrote (2408)	12/20/1998 11:01:00 AM
From: Gary L. Kepler	Respond to of 4676

FYI From: george wohanka on the XOMA thread: ama-assn.org:80/special/hiv/newsline/reuters/12154605.htm Catheter complication rate high among AIDS patients treated for CMV retinitis WESTPORT, Dec 15 (Reuters Heath) - Complications from placement of an indwelling central venous catheter to treat AIDS-related cytomegalovirus (CMV) retinitis infection are a significant cause of morbidity in these patients, according to a team from Johns Hopkins University School of Medicine. Dr. Jennifer E. Thorne and her co-investigators in Baltimore, Maryland, reviewed the records of 388 AIDS patients treated for CMV retinitis requiring daily infusion of drugs (ganciclovir and foscarnet) at their institution during a 12-year period. Along with the incidence of catheter complications, the researchers also noted the risk factors and outcomes associated with these episodes. Their findings appear in the December 3rd issue of AIDS. "Of the 388 patients who received long-term indwelling catheters for treatment of CMV retinitis, 172 (44.3%) had at least one complication from the indwelling catheter." They calculated the rate to be "1.2 complications per person-year, or 0.33 complications per 100 catheter-days." Seventy-five percent of the subjects required at least one hospitalization due to a catheter complication. The investigators found the mortality following the first catheter complication to be 5.8%. Most of the complications were infections (89.0%), which included probable or confirmed sepsis, tunnel infections, and exit site infections. Other complications included thrombosis and mechanical problems related to positioning of the catheter or the catheter cuff. Patients who reported using injection drugs during treatment appeared to be at increased risk of catheter complications, but former injection drug users (IDUs) did not. "These data suggest that long-term indwelling catheters should be avoided in patients who are practicing IDU, particularly if other treatment options are available." Overall, Dr. Thorne's group concludes that catheter-related complications are a substantial problem for AIDS patients being treated for CMV retinitis. They suggest that new treatment alternatives, such as oral ganciclovir following placement of an intraocular ganciclovir implant, may reduce morbidity in these patients. AIDS 1998;12:2321-2327. © 1998 Reuters Health Information. All rights reserved. -------------------------------------------------------------------------------- This site produced by the Journal of the American Medical Association with support from Glaxo Wellcome Inc. © 1998 American Medical Association. All rights reserved.