Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter

Meier, Michelle; Mortensen, Frank Viborg; Madsen, Harold F.

doi:10.1177/2058460115579934

Cited by 16 publications

(18 citation statements)

References 18 publications

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“…Although the technical safety and clinical efficacy of indwelling abdominal drains for advanced cancer patients with refractory ascites have been demonstrated (3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), bacterial colonization and subsequent drain-related infection remain to be common concerns for these types of long-term drains inserted into the peritoneal cavity as in patients with other types of long-term indwelling catheters, for example, Tenckhoff catheters (26), central venous access (27)(28)(29) and urinary catheters (30). Colonization of these catheters can lead to resistance to antibiotic treatment because of the formation of bacterial biofilm (31)(32)(33).…”

Section: Bacterial Colonization and Drain-related Infectionmentioning

confidence: 99%

Patterns and infection outcomes of bacterial colonization in patients with indwelling abdominal drains for malignant ascites

Chan¹,

Cheung²,

Chan³

et al. 2020

Ann Palliat Med

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Background: Indwelling abdominal drains for intermittent drainage is an effective treatment for refractory malignant ascites, bacterial colonization and subsequent drain-related infection is however a common concern. This study aimed to investigate the patterns of bacterial colonization and the subsequent infection outcomes in patients with indwelling abdominal drains. Methods: All consecutive advanced cancer patients with newly inserted indwelling abdominal drains and who were under the service of the ascites clinic of our institution for intermittent drainage between January 2011 and March 2018 were screened for study eligibility. Patients with positive surveillance ascitic fluid culture without immediate drain-related infection were included in the final analysis. Clinical information during the drainage period was prospectively collected using standardized clinical assessment forms. These assessment forms and other medical records were retrospectively reviewed. Results: Sixty nine patients developed bacterial colonization without immediate infection during the study period. The most common cancer diagnosis was hepatocellular carcinoma (HCC), which comprise 30.4% of the population. Central venous catheters (CVCs) were inserted in 76.8% of patients and pigtail drains in 23.2% as the indwelling abdominal drain. The median duration from drain insertion to the development of bacterial colonization was 18.0 days. Staphylococci, Diphtheroid bacilli and Enterococci were the most common types of bacteria isolated during colonization. Thirty patients (43.5%) developed drain-related infection subsequently and the median time from bacterial colonization to development of infection was 14.5 days.The incidence rate of drain-related infection after bacterial colonization was 1.78 per 100-catheter days and the 1-month infection-free survival was 54.4%. Five patients (7.2%) developed peritonitis and 4 of them died from the infection episode. Decrease in body mass index (BMI) (P=0.03), having 3 or more episodes of drainage in the ascites clinic before bacterial colonization (P=0.03), presence of Escherichia coli (P=0.04) and Bacillus species (P=0.04) in surveillance ascitic fluid culture were significantly correlating with infection outcomes in univariate analyses. HCC as cancer diagnosis (OR 8.85, 95% CI: 1.86-42.07, P=0.006) and decrease in body weight (OR 1.20, 95% CI: 1.02-1.42, P=0.03) were significant factors that correlated with infection outcomes in multivariate analysis. Conclusions: Bacterial colonization and subsequent progression into drain-related infection are common in patients on indwelling abdominal drains for malignant ascites. Staphylococci is the most common type of bacteria causing both colonization and subsequent drain-related infection. HCC and decrease in body weight are significant factors that correlate with infection outcomes after bacterial colonization.

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Section: Bacterial Colonization and Drain-related Infectionmentioning

confidence: 99%

Patterns and infection outcomes of bacterial colonization in patients with indwelling abdominal drains for malignant ascites

Chan¹,

Cheung²,

Chan³

et al. 2020

Ann Palliat Med

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“…Subsequently, several case series have adapted use of an indwelling pleural catheter (IPC) in malignant ascites wherein an IPC is inserted intra‐peritoneally after tunnelling (herein called indwelling peritoneal catheter (IPeC)). The published efficacy and safety results of IPeC are promising with a reduced need of further LVP, an improvement of symptoms and QoL and a low risk of complications including infection (5.4%) . This is the first Australian report on the experience of placing an IPeC for management of recurrent malignant ascites.…”

Section: Introductionmentioning

confidence: 83%

Use of indwelling pleural/peritoneal catheter in the management of malignant ascites: a retrospective study of 48 patients

Chan

Badiei

Tan

et al. 2020

Internal Medicine Journal

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Background Patients suffering from malignant ascites usually require repeated large volume paracentesis (LVP) for symptomatic relief. This often requires hospital admission and has inherent risks. Aims To report the first Australian experience of placing tunnelled indwelling peritoneal catheters (IPeC) for management of recurrent malignant ascites. Methods A retrospective study was conducted of tunnelled IPeC use in patients with symptomatic malignant ascites in four hospitals in Western Australia (from 2010 to 2018). Procedure data, success rate and safety profile were collected from a database. Results Forty‐eight patients (median age 65 years; female 56%) underwent 51 peritoneal catheter insertion procedures that were performed mostly by pleural specialists. The majority of patients (96%) had prior LVP (median two drainages, interquartile range (IQR) 1–4) before IPeC insertion. The IPeC was inserted successfully under ultrasound guidance in all patients. The median length of hospital stay for IPeC insertion and initial ascites drainage was 2 days (IQR 2–3 days) and most patients (96%) did not require further paracentesis after IPeC placement. The majority (96%) of patients experienced relief from ascites symptoms after catheter insertion. Most IPeC‐related adverse events were self‐limiting, including pain (in 25% cases), transient hypotension after initial fluid drainage (10%), peritoneal fluid leakage (10%), bacterial peritonitis (8%), fluid loculation (2%) and catheter dislodgement (2%). Six (12%) patients had IPeC removed. All patients with bacterial peritonitis responded to antibiotics and one required catheter removal. Conclusions Use of tunnelled IPeC improves symptoms and can minimise further invasive drainage procedures in patients with symptomatic malignant ascites. Placement of IPeC was associated with a low rate of adverse events, most of which could be managed conservatively.

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“…Many studies have discussed the effects of treatment options on hospital length of stay among patients with MRA. [11][12][13][14] However, the effects of patient-specific variables on hospital length of stay have not been adequately discussed, and our study is one of the first few to address this gap. Malignancy-related ascites is a serious condition for which treatment is primarily palliative, and hence treatment options should be minimally invasive and hospital stay should be minimal.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

Ramamoorthy

Rubens

Saxena

et al. 2020

Am J Hosp Palliat Care

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Objective: Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. Methods: The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. Results: There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Conclusions: Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.

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Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter

Cited by 16 publications

References 18 publications

Patterns and infection outcomes of bacterial colonization in patients with indwelling abdominal drains for malignant ascites

Patterns and infection outcomes of bacterial colonization in patients with indwelling abdominal drains for malignant ascites

Use of indwelling pleural/peritoneal catheter in the management of malignant ascites: a retrospective study of 48 patients

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

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