Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli

Abstract

BackgroundImplantable venous access port (IVAP)-related blood stream infections (BSIs) are one of the most common complications of implantable venous ports. The risk factors and pathogens for IVAP-related BSIs are still controversial.MethodsWe retrospectively reviewed all patients who received IVAPs at a Hospital in Taiwan from January 1, 2011 to June 31, 2014. Two types of venous port, BardPort® 6.6 fr (Bard port) and Autosuture Chemosite® 7.5 fr (TYCO port) were used. All patients with clinically proven venous port-related BSIs were enrolled.ResultsA total of 552 patients were enrolled. There were 34 episodes of IVAP-related BSIs during the study period for a total incidence of 0.177 events/1000 catheter days. Port type (TYCO vs. Bard, HR = 7.105 (95 % confidence interval (CI), 1.688–29.904), p = 0.0075), age > 65 years (HR = 2.320 (95 % CI, 1.179–4.564), p = 0.0148), and lung cancer (HR = 5.807 (95 % CI, 2.946–11.447), p < 0.001) were risk factors for port infections. We also found that no local sign of infection was significantly associated with the growth of gram-negative bacilli (p = 0.031).ConclusionsTYCO venous ports, age > 65 years, and lung cancer were all significant risk factors for IVAP-related BSIs, and no sign of infection was significantly associated with the growth of gram-negative bacilli.

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

“…By contrast, the use of parenteral nutrition, another recognized risk factor for TIVAP-related infection [ 34 – 36 ], was used more frequently in patients with TIVAP-related infection, but this finding remained infrequent and was not confirmed in multivariate analysis. While local signs of infection have been reported to be present from 7 to 33% of the cases [ 8 – 10 , 17 , 20 ], in our patient series, only few had local sign of infection (18%). But it’s important to specify that information about local signs of infection is difficult to collect in a retrospective study.…”

“…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).…”

“…In case of tunnel or port-pocket infection, TIVAP-related bloodstream infection is obviously strongly suspected and the device should be promptly removed [ 6 ]. However, local signs of infection are frequently lacking [ 7 – 10 ]. International guidelines support the removal of TIVAP in case of TIVAP-related bloodstream infection, with complication like severe sepsis or/and septic shock (use of vasopressors) [ 6 , 11 ], although no data support this practice.…”

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

“…Although the majority of bacteria isolated among the cases of BSI were GNB, a considerable proportion were MDR strains. The (16)(17)(18)(19)(20).…”

“…In our risk factor analysis, LTCVC-associated infection caused by MDR bacteria was associated with higher mortality. Typically, LTCVC-associated infections occur in outpatients, and the rate of infection with MDR bacteria is low (16,27). In a study evaluating 1,148 episodes of bacteremia in cancer patients (28), infection with MDR bacteria was associated with poorer outcomes: inappropriate empirical antibiotic therapy, persistence of bacteremia, septic metastasis, and a higher early case-fatality rate.…”