Changes in the spectrum of organisms causing bacteremia and fungemia in immunocompromised patients due to venous access devices.

A significant increase in the use of vascular access devices has changed the spectrum of organisms causing bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. This paper documents the 1988 laboratory experience with bacteremia and fungemia and contrasts some of that data with information obtained in 1984. In 1988, 439 tunnelled-catheters and 355 ports were inserted in patients; 2,778 organisms were subsequently recovered from 933 episodes of bacteremia and fungemia. Fifty-percent of the episodes of bacteremia and fungemia were vascular access device-related. Compared to 1984, the relative incidence of bacteremia due to gram-positive organisms increased from 33 to 43%, polymicrobic cultures increased from 24 to 27%, and the number of organisms with colony counts greater than 100 cfu/ml increased from 24 to 44%. In 1988, device-related sepsis was often caused by Acinetobacter spp., Bacillus spp., Corynebacterium spp., pseudomonads other than Pseudomonas aeruginosa, and coagulase-negative staphylococci. Infection was also caused by species of flavobacteria, Micrococcus, and Rhodotorula. Efforts required for identification of many of the newer pathogens have escalated material and personnel costs.