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Incidence and Risk Factors of Infectious Complications Related to Implantable Venous-Access Ports

  • Shim, Jisue (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Seo, Tae-Seok (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Song, Myung Gyu (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Cha, In-Ho (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kim, Jun Suk (Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Choi, Chul Won (Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Seo, Jae Hong (Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Oh, Sang Cheul (Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine)
  • Received : 2013.08.16
  • Accepted : 2014.05.07
  • Published : 2014.07.01

Abstract

Objective: The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs). Materials and Methods: From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. Results: Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). Conclusion: The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

Keywords

References

  1. Narducci F, Jean-Laurent M, Boulanger L, El Bedoui S, Mallet Y, Houpeau JL, et al. Totally implantable venous access port systems and risk factors for complications: a oneyear prospective study in a cancer centre. Eur J Surg Oncol 2011;37:913-918 https://doi.org/10.1016/j.ejso.2011.06.016
  2. Fischer L, Knebel P, Schroder S, Bruckner T, Diener MK, Hennes R, et al. Reasons for explantation of totally implantable access ports: a multivariate analysis of 385 consecutive patients. Ann Surg Oncol 2008;15:1124-1129 https://doi.org/10.1245/s10434-007-9783-z
  3. Biffi R, de Braud F, Orsi F, Pozzi S, Mauri S, Goldhirsch A, et al. Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol 1998;9:767-773 https://doi.org/10.1023/A:1008392423469
  4. Samaras P, Dold S, Braun J, Kestenholz P, Breitenstein S, Imhof A, et al. Infectious port complications are more frequent in younger patients with hematologic malignancies than in solid tumor patients. Oncology 2008;74:237-244 https://doi.org/10.1159/000151393
  5. Pandey N, Chittams JL, Trerotola SO. Outpatient placement of subcutaneous venous access ports reduces the rate of infection and dehiscence compared with inpatient placement. J Vasc Interv Radiol 2013;24:849-854 https://doi.org/10.1016/j.jvir.2013.02.012
  6. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1-45 https://doi.org/10.1086/599376
  7. Gebauer B, El-Sheik M, Vogt M, Wagner HJ. Combined ultrasound and fluoroscopy guided port catheter implantation-- high success and low complication rate. Eur J Radiol 2009;69:517-522 https://doi.org/10.1016/j.ejrad.2007.10.018
  8. Biffi R, Corrado F, de Braud F, de Lucia F, Scarpa D, Testori A, et al. Long-term, totally implantable central venous access ports connected to a Groshong catheter for chemotherapy of solid tumours: experience from 178 cases using a single type of device. Eur J Cancer 1997;33:1190-1194 https://doi.org/10.1016/S0959-8049(97)00039-7
  9. Brown DF, Muirhead MJ, Travis PM, Vire SR, Weller J, Hauer-Jensen M. Mode of chemotherapy does not affect complications with an implantable venous access device. Cancer 1997;80:966-972 https://doi.org/10.1002/(SICI)1097-0142(19970901)80:5<966::AID-CNCR20>3.0.CO;2-T
  10. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998;22:12-16 https://doi.org/10.1007/s002689900342
  11. Lyon RD, Griggs KA, Johnson AM, Olsen JR. Long-term followup of upper extremity implanted venous access devices in oncology patients. J Vasc Interv Radiol 1999;10:463-471 https://doi.org/10.1016/S1051-0443(99)70066-7
  12. Wolosker N, Yazbek G, Nishinari K, Malavolta LC, Munia MA, Langer M, et al. Totally implantable venous catheters for chemotherapy: experience in 500 patients. Sao Paulo Med J 2004;122:147-151 https://doi.org/10.1590/S1516-31802004000400003
  13. Caers J, Fontaine C, Vinh-Hung V, De Mey J, Ponnet G, Oost C, et al. Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports. Support Care Cancer 2005;13:325-331 https://doi.org/10.1007/s00520-004-0723-1
  14. Ahn SJ, Kim HC, Chung JW, An SB, Yin YH, Jae HJ, et al. Ultrasound and fluoroscopy-guided placement of central venous ports via internal jugular vein: retrospective analysis of 1254 port implantations at a single center. Korean J Radiol 2012;13:314-323 https://doi.org/10.3348/kjr.2012.13.3.314
  15. Gapany C, Tercier S, Diezi M, Clement C, Lemay K, Joseph JM. Frequent accesses to totally implanted vascular ports in pediatric oncology patients are associated with higher infection rates. J Vasc Access 2011;12:207-210 https://doi.org/10.5301/JVA.2011.6258
  16. Fatkenheuer G, Buchheidt D, Cornely OA, Fuhr HG, Karthaus M, Kisro J, et al. Central venous catheter (CVC)-related infections in neutropenic patients--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 2003;82 Suppl 2:S149-S157 https://doi.org/10.1007/s00277-003-0769-z
  17. Lebeaux D, Zarrouk V, Leflon-Guibout V, Lefort A, Fantin B. [Totally implanted access port-related infections: features and management]. Rev Med Interne 2010;31:819-827 https://doi.org/10.1016/j.revmed.2010.06.014
  18. Teichgraber UK, Kausche S, Nagel SN. Evaluation of radiologically implanted central venous port systems explanted due to complications. J Vasc Access 2011;12:306-312 https://doi.org/10.5301/JVA.2011.7739
  19. Aitken DR, Minton JP. The "pinch-off sign": a warning of impending problems with permanent subclavian catheters. Am J Surg 1984;148:633-636 https://doi.org/10.1016/0002-9610(84)90340-4
  20. Hinke DH, Zandt-Stastny DA, Goodman LR, Quebbeman EJ, Krzywda EA, Andris DA. Pinch-off syndrome: a complication of implantable subclavian venous access devices. Radiology 1990;177:353-356 https://doi.org/10.1148/radiology.177.2.2217768
  21. Lebeaux D, Larroque B, Gellen-Dautremer J, Leflon-Guibout V, Dreyer C, Bialek S, et al. Clinical outcome after a totally implantable venous access port-related infection in cancer patients: a prospective study and review of the literature. Medicine (Baltimore) 2012;91:309-318 https://doi.org/10.1097/MD.0b013e318275ffe1
  22. Di Carlo I, Toro A, Pulvirenti E, Palermo F, Scibilia G, Cordio S. Could antibiotic prophylaxis be not necessary to implant totally implantable venous access devices? Randomized prospective study. Surg Oncol 2011;20:20-25 https://doi.org/10.1016/j.suronc.2009.09.003
  23. Karanlik H, Kurul S, Saip P, Unal ES, Sen F, Disci R, et al. The role of antibiotic prophylaxis in totally implantable venous access device placement: results of a single-center prospective randomized trial. Am J Surg 2011;202:10-15 https://doi.org/10.1016/j.amjsurg.2010.05.005
  24. Gastmeier P, Geffers C. Prevention of catheter-related bloodstream infections: analysis of studies published between 2002 and 2005. J Hosp Infect 2006;64:326-335 https://doi.org/10.1016/j.jhin.2006.07.005

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