Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
TOTALLY IMPLANTABLE VASCULAR ACCESS FOR HOME ANTIMICROBIAL THERAPY (MEETING ABSTRACT)
Third International Congress on the Neo-adjuvant Chemotherapy. February 6-9, 1991, Paris, France, p. 40, 1991.. Unique Identifier : AIDSLINE ICDB/92677639 Lucht F; Fresard A; Service des maladies Infectieuses, Chu St Etienne, France
Abstract:
Since the early 1980s, the needs of patients (pts) in long-term care increased substantially. These needs appear to be attributable predominantly to pts recently hospitalized for acute conditions rather than pts with chronic debilitating conditions. We have an experience in the treatment of chronic infected pts. We have treated 42 pts (38, chronic Gram-negative bacilli osteomyelitis; 4, AIDS with, respectively, 2 CMV retinitis, and 1 Cryptococcus neoformans meningitis, 1 Candida bacteremia). All the pts received antimicrobial agents via an implantable system ('Port-A-Cath,' Pharmacia). The pts with osteomyelitis received ceftriaxone and pefloxacin for 6-13 mo. Despite oral amphotericin B, 3 of these pts had systemic candidiasis (between 2 and 3 mo after the start of therapy), with septic shock in 3 cases. Since the use of ketoconazole and more recently of fluconazole, we never observed systemic candidiasis. We agree with others that home iv antimicrobial therapy offers several benefits, including cost savings, and that totally implantable venous access systems are safe and comfortable devices for chemotherapy and antiviral therapy. But clinicians must be aware of the major risk of systemic candidiasis when using such systems for long courses of broad-spectrum antimicrobials. Oral ketoconazole or fluconazole may provide valuable prophylaxis against these superinfections. Direct costs and emotional inconvenience are demanding other medical practices such as home iv antibiotic therapy. This practice is feasible with a therapy team, it benefits the pts with a more satisfying life-style, and the community with a better use of acute-care beds and a substantial reduction in hospital costs. A better system of reimbursing for long-term care is required.
Keywords: Ambulatory Care Antibiotics/*ADMINISTRATION & DOSAGE Chronic Disease Home Care Services Human Infection/*DRUG THERAPY *Infusion Pumps, Implantable Osteomyelitis/DRUG THERAPY Patient Care Team Quality of Life ABSTRACT
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Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
