Outcome of totally implantable venous-access port-related infections

Vidal, M.; Genillon, J.P.; Forestier, E.; Trouiller, Sébastien; Pereira, Bruno; Mrozek, Natacha; Auméran, C.; Lesens, Olivier

doi:10.1016/j.medmal.2015.12.006

Cited by 28 publications

(29 citation statements)

References 30 publications

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“…The most common agent of LTCVC-associated infection in our cohort was S. aureus, in agreement with previous reports (3,15). Although the majority of bacteria isolated among the cases of BSI were GNB, a considerable proportion were MDR strains.…”

Section: Discussionsupporting

confidence: 93%

“…In a randomized, placebo-controlled multicenter trial of ALT, bacteremia with the same microbial strain after the end of treatment occurred in 39% of the cases in the placebo arm compared with only 14% in the ALT arm (25). In another study, which analyzed 82 patients with tunneled CVC-associated infections, the mortality rate was 83% among the patients for whom ALT was not used or the CVC was not removed (15).…”

Section: Discussionmentioning

confidence: 99%

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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Freire

Pierrotti

Zerati

et al. 2018

Antimicrob Agents Chemother

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The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Freire

Pierrotti

Zerati

et al. 2018

Antimicrob Agents Chemother

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“…Being the first study addressing this issue in the ICU, our results are hardly comparable. Indeed, most of previous studies were conducted outside the ICU [ 4 , 5 , 10 , 17 , 19 , 20 , 29 ]. For instance, in two studies [ 8 , 9 ], among patient whose TIVAP was removed because of a suspected infection, TIVAP-related infection was confirmed in two thirds of the patients (19/29 and 15/23, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, removal of TIVAP is an important decision that should be supported by clinical evidences, but predictive factors of TIVAP-related infections are lacking in ICU patients. Likewise, no study regarding the prognosis of TIVAP-related infections has been conducted outside the ICU [ 16 – 20 ]. In light with this, the present study was designed to address three main objectives: (1) to determine the proportion of confirmed TIVAP-related infections in a population of patients admitted in the ICU in whom a TIVAP was removed for life-threatening sepsis, (2) to identify predictive factors of confirmed TIVAP infection in patients admitted to the ICU and (3) to assess short- and long-term outcome of patients with TIVAP-related infection and compare them with their counterparts in whom TIVAP was removed without confirmation of infection.…”

Section: Introductionmentioning

confidence: 99%

Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study

Lecronier

Valade

Bigé

et al. 2018

Ann. Intensive Care

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BackgroundWhile no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis.MethodsDuring this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections.ResultsOne hundred and fifty-one patients (58 ± 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8–0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1–15.6), p = 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p = 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05–0.5), p < 0.01].ConclusionsTIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0383-9) contains supplementary material, which is available to authorized users.

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“…Although this system has been proven to have less chance of infection when compared to the exteriorized catheter, CRBSI remain a concern. During the on-going period of this study, we found that the neck vein approach was superior to the subclavian approach in terms of a significantly lower incidence of CRBSI 7,19 , and based on this finding we modified our surgical protocol to perform internal jugular venous puncture under ultrasonographic guidance as the first choice. Now in our institution the use of fluoroscopy and flow check before the end of a TIVAD procedure are mandatory.…”

Section: Discussionmentioning

confidence: 98%

An Appraisal of Totally Implantable Venous Access Devices in Pediatric Cancers

Sangkhathat

2020

Smj

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Objective: To appraise the experience of a pediatric cancer center in Thailand regarding employment of totally implantable venous access devices (TIVAD). Methods: The records of consecutive patients aged less than 15 years diagnosed with malignancy and underwent an implantation from the years 2010 to 2018 were reviewed with the main focus on effective duration and complications of the device. Changes in our practice in perioperative care were also reviewed. Results: A total of 150 lines in 144 patients (103 hematologic malignancies and 41 solid tumors) were included with average age 6.4 years. Neck vein access was used in 62 lines, subclavian vein access in 88 lines. The median follow-up period was 973 days. Immediate complications occurred in 13 cases (9.4%). Excluding cases with death from unrelated causes, the overall TIVAD survival was 985.1 days while event-free device survival was 797.6 days. In cases of hematologic malignancies, which were the main users, 1000-day overall survival and event-free survival of TIVAD were 83.7% and 78.2%, respectively. Catheter-related infections and mechanical obstruction were the 2 most prevalent problems, occurring in 0.20 and 0.08 events/1,000 catheter days, respectively. Infection occurred in 23 patients and gram-negative bacilli were most common. Moreover, subclavian access was significantly related with infectious complications when compared to the neck vein approach. Conclusion: A TIVAD can be used for chemotherapy longer than 3 years without serious complications. Refinement of surgical techniques and improving care process may improve the longevity of the line.

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Outcome of totally implantable venous-access port-related infections

Cited by 28 publications

References 30 publications

Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study

An Appraisal of Totally Implantable Venous Access Devices in Pediatric Cancers

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