Outcome of totally implantable central venous-access port-related infections

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Abstract:

OBJECTIVE: We aimed to study factors associated with the outcome of totally implantable venous-access port (TIVAP)-related infections.

PATIENTS AND METHODS: We conducted a prospective and observational cohort study of patients presenting with a solid tumor and TIVAP-related infection.

RESULTS: We monitored 97 patients for 12weeks. The case fatality at 12weeks was high (54%). Factors associated with case fatality at week 12 included patients’ underlying cancer (metastatic status, parenteral nutrition, home care). Infectious complications (local abscess, hematogenous metastases, infection recurrence, septic shock) were frequently observed (48%). The delay in TIVAP removal was the only variable significantly associated with complications (TIVAP removed more than a week after removal decision, P=0.001, or more than a week after onset of clinical symptoms, P=0.002). On the basis of IDSA guidelines, we also observed that 25% of patients whose TIVAP had been removed could have benefited from a conservative treatment. Infections occurring within a month of TIVAP implantation were significantly associated with a Staphylococcus aureus infection (P=0.008).

CONCLUSION: Case fatality is high in this population of patients due to the poor status of patients. TIVAP should be promptly removed when appropriate but the patient’s poor status might delay or even prevent its removal. Some patients could instead benefit from a conservative treatment. There is currently no recommendation for this therapeutic option and studies are needed to clarify its efficacy. Additionally, infection occurring within a month of TIVAP insertion could be a supplementary criterion for removal as S. aureus is associated with early infection.

Reference:

Vidal, M., Genillon, J.P., Forestier, E., Trouiller, S., Pereira, B., Mrozek, N., Aumeran, C. and Lesens, O. (2016) Outcome of totally implantable venous-access port-related infections. Médecine et Maladies Infectieuses. January 14th. [epub ahead of print].

DOI: 10.1016/j.medmal.2015.12.006.

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