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Barakzai MD, Bozic D, Gupta S, Amirabadi A, Temple M, Chiramel GK, Parra D, Gasparetto A, Amaral JG. Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal? J Vasc Interv Radiol 2024:S1051-0443(24)00126-X. [PMID: 38342222 DOI: 10.1016/j.jvir.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024] Open
Abstract
PURPOSE To assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal due to infection either within the first 30 days or between 30 and 90 days after CVAD insertion. MATERIALS AND METHODS One hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. RESULTS Patients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. CONCLUSIONS Fever at diagnosis in patients with leukemia is not a predictor of CVAD removal due to infection.
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Affiliation(s)
- Muhammad Danish Barakzai
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Dalia Bozic
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Temple
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - George Koshy Chiramel
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Dimitri Parra
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Alessandro Gasparetto
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Joao Guilherme Amaral
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Complications After Implantation of Subcutaneous Central Venous Ports: Focus on Infection and Catheter Pinch-off. Int Surg 2022. [DOI: 10.9738/intsurg-d-15-00316.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
The objective of this study was to determine the causes of postoperative complications associated with subcutaneous central venous ports.
Summary of Background Data
Central venous ports were subcutaneously implanted in 523 patients between January 2005 and December 2013.
Methods
The purpose of port implantation was administration of chemotherapy in 439 patients and home central venous nutrition in 84 patients. The underlying disease was malignant in 481 patients and benign in 42.
Results
The median follow-up was 12 months (range, 1–99 months), and postoperative complications developed in 69 patients (13%). Infection occurred in 40 patients (7.6%) and catheter pinch-off in 11 patients (3%). Significant risk factors for infection were nutritional port placement (P < 0.001) and use of a femoral vein approach (P = 0.001). A left subclavian approach was a significant risk factor for catheter pinch-off (P = 0.003).
Conclusions
Postoperative complications, mainly infections and catheter pinch-off, developed in 13% of the patients. As for measures against complications, a femoral vein approach should be avoided to prevent infection. Moreover, because ports for parenteral nutrition require multiple punctures, methods to reduce the number of punctures and techniques for disinfection and management should be reevaluated. To prevent catheter pinch-off, an internal jugular vein approach should be used instead of a left subclavian approach.
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Böll B, Schalk E, Buchheidt D, Hasenkamp J, Kiehl M, Kiderlen TR, Kochanek M, Koldehoff M, Kostrewa P, Claßen AY, Mellinghoff SC, Metzner B, Penack O, Ruhnke M, Vehreschild MJGT, Weissinger F, Wolf HH, Karthaus M, Hentrich M. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2021; 100:239-259. [PMID: 32997191 PMCID: PMC7782365 DOI: 10.1007/s00277-020-04286-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.
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Affiliation(s)
- Boris Böll
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, Magdeburg, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Oncology, University Medicine Göttingen, Georg-August-University, Göttingen, Germany
| | - Michael Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Til Ramon Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Kostrewa
- Department of Hematology and Oncology, Campus Fulda, Philipps-University Marburg, Fulda, Germany
| | - Annika Y Claßen
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd Metzner
- Department of Hematology and Oncology, University Hospital Oldenburg, Oldenburg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Hematology and Oncology, Helios Klinikum Aue, Aue, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Weissinger
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department III of Internal Medicine, Hematology, Oncology and Hemostaseology, Südharzklinikum, Nordhausen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
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Beck O, Muensterer O, Hofmann S, Rossmann H, Poplawski A, Faber J, Gödeke J. Central Venous Access Devices (CVAD) in Pediatric Oncology Patients-A Single-Center Retrospective Study Over More Than 9 Years. Front Pediatr 2019; 7:260. [PMID: 31294007 PMCID: PMC6603206 DOI: 10.3389/fped.2019.00260] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/07/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Central venous access devices (CVAD) provide important benefits in the management of oncological pediatric patients. However, these catheters are responsible for severe complications. Methods: In this context, we aimed to analyze all patients receiving a CVAD in the Department of Pediatric Hematology and Oncology of the University hospital of Mainz over a period of 9 years, focused on CVAD related complications. Data on demographics, as well as intraoperative and postoperative complications were extracted. Results: A total of 296 patients with a mean age 93.2 ± 62.4 months were analyzed. The majority suffered from leukemia (n = 91, 30.7%), lymphomas (n = 50, 16.9%), and brain tumors (n = 48, 16.2%). In 63 (21.3) patients, complications were observed. No death caused by complications of CVADs was found in our series. Catheter-related blood stream infections (BSI) (7.4%) were most prevalent, followed by dislodgements (5.4%), occlusions (2.7%), thrombosis (2.4%), and catheter leakage (2.4%). Insertion site infections were observed in three patients (1.0%). Fifty-nine percent of all patients with catheter-related BSI suffered from Leukemia. In patients with Catheter-related BSIs we detected the condition leukemia as the underlying disease as a risk factor compared to solid tumors as the underlying disease. Overall, totally implanted devices (ports) have a lower complication rate than tunneled catheter. Conclusion: Implantation of CVADs seems to be safe and reliable in this large pediatric patient cohort. Even if complications occur in the long-term management of CVADs, they can be treated successfully and long-term catheter survival rates are excellent.
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Affiliation(s)
- Olaf Beck
- Children's Hospital, Pediatric Hematology, Oncology and Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oliver Muensterer
- Children's Hospital, Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sarah Hofmann
- Children's Hospital, Pediatric Hematology, Oncology and Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jörg Faber
- Children's Hospital, Pediatric Hematology, Oncology and Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jan Gödeke
- Children's Hospital, Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Lecronier M, Valade S, Bigé N, de Prost N, Roux D, Lebeaux D, Maury E, Azoulay E, Demoule A, Dres M. Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study. Ann Intensive Care 2018; 8:41. [PMID: 29594891 PMCID: PMC5874227 DOI: 10.1186/s13613-018-0383-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/08/2018] [Indexed: 12/29/2022] Open
Abstract
Background While 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. Methods During 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. Results One 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]. Conclusions TIVAP-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 material The online version of this article (10.1186/s13613-018-0383-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Lecronier
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.
| | - Sandrine Valade
- Service de Réanimation médicale, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand-Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naike Bigé
- Service de Réanimation médicale, Groupe Hospitalier Est Parisien, Hôpital Saint-Antoine Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas de Prost
- Service de Réanimation médicale, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Damien Roux
- Service de Réanimation médico-chirurgicale, Groupe Hospitalier Paris Nord, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eric Maury
- Service de Réanimation médicale, Groupe Hospitalier Est Parisien, Hôpital Saint-Antoine Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elie Azoulay
- Service de Réanimation médicale, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand-Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Demoule
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.,INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Martin Dres
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.,INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
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Pinelli F, Cecero E, Degl'Innocenti D, Selmi V, Giua R, Villa G, Chelazzi C, Romagnoli S, Pittiruti M. Infection of totally implantable venous access devices: A review of the literature. J Vasc Access 2018; 19:230-242. [PMID: 29512430 DOI: 10.1177/1129729818758999] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient's quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients' morbidity and mortality-both in the hospital or outpatient setting-and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device-related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device-related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device-related infections.
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Affiliation(s)
- Fulvio Pinelli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elena Cecero
- 2 Department of Health Science, University of Florence, Florence, Italy
| | | | - Valentina Selmi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rosa Giua
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Gianluca Villa
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Cosimo Chelazzi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- 4 Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Edun B, Shah A, Durkin M, Whitmire M, Williams SP, Albrecht H, Al-Hasan M, Weissman S. Non-tuberculous mycobacterial bloodstream infections in patients with indwelling vascular catheters - the role of sickle cell anaemia. Infect Dis (Lond) 2016; 49:341-346. [PMID: 27911152 DOI: 10.1080/23744235.2016.1262058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Few studies have examined risk factors for nontuberculous mycobacteria (NTM) bloodstream infections (BSI) involving indwelling vascular catheters (IDVC). Sickle cell anaemia (HbSS/SC) is known to affect several aspects of the immune system leading to relative immune deficiency. The purpose of this retrospective nested case-control study was to determine if HbSS/SC is a risk factor for NTM BSI among individuals with IDVCs. METHODS All NTM IDVC infections (cases) at two tertiary hospitals from 2008 to 2014 were reviewed. Cases were matched 2:1 with controls who had IDVC infections due to organisms other than NTM. Matching criteria included age within 10 years and IDVC infection within three months of index case. Logistic regression was used to identify risk factors for IDVC infection due to NTM. RESULTS Nineteen NTM BSIs were identified. Three cases were excluded because they did not have IDVCs at the time their BSI was identified. Sixteen cases of NTM IDVC infection were matched to 32 controls with IDVC infections due to other organisms. The mean age of patients with IDVC infections was 48.5 years and 28 (58%) were male. Compared to the control group those with NTM BSI were more likely to have HbSS/SC 38% (6/16) versus 6% (2/32) (p = .006). CONCLUSION IDVCs are a risk factor for NTM BSI. Sickle cell anaemia appears to be a risk factor for IDVC infections due to NTM. This study is limited by the small sample size. A larger study is needed to further investigate the association between HbSS/SC and NTM IDVC infections.
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Affiliation(s)
- Babatunde Edun
- a Department of Medicine, Division of Infectious Diseases , University of South Carolina , Columbia , SC , USA
| | - Ansal Shah
- a Department of Medicine, Division of Infectious Diseases , University of South Carolina , Columbia , SC , USA
| | - Martin Durkin
- b Department of Medicine, Palmetto Health Richland Hospital , Columbia , SC , USA
| | - Melanie Whitmire
- c Department of Internal Medicine , University of South Carolina School of Medicine , Columbia , SC , USA
| | | | - Helmut Albrecht
- a Department of Medicine, Division of Infectious Diseases , University of South Carolina , Columbia , SC , USA
| | - Majdi Al-Hasan
- a Department of Medicine, Division of Infectious Diseases , University of South Carolina , Columbia , SC , USA
| | - Sharon Weissman
- a Department of Medicine, Division of Infectious Diseases , University of South Carolina , Columbia , SC , USA
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9
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Almasi-Sperling V, Hieber S, Lermann J, Strahl O, Beckmann MW, Lang W, Sagban TA. Femoral Placement of Totally Implantable Venous Access Ports in Patients with Bilateral Breast Cancer. Geburtshilfe Frauenheilkd 2016; 76:53-58. [PMID: 26855441 DOI: 10.1055/s-0035-1558173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Aim of this study was to determine the rate of complications following femoral placement of totally implantable venous access ports (f-TIVAP) in women with bilateral breast cancer, with a special focus on long-term function, deep vein thrombosis (DVT), and port infection. Methods: 73 patients with bilateral breast cancer treated between October 2000 and January 2013 with placement of an f-TIVAP using a transfemoral approach were retrospectively reviewed. All patients were followed up, and all complications of f-TIVAP were recorded. Results: The median age was 62.5 years (range: 35-86 years). Four patients received f-TIVAP under local anesthesia, and 69 underwent placement under general anesthesia. Mean follow-up was 33.7 months (SD 25.9; range: 0.2-93.5 months). Complications over the entire period of observation included infections in 21 %, DVT in 19 % and catheter occlusion in 12 %. Patients receiving chemotherapy who developed leukopenia were more likely to experience DVT at the access site (p = 0.037). There was a trend towards a higher infection rate when the device was used more often (p = 0.084). Conclusion: Although the rates of complications in the longer term, especially device infections and DVTs, appeared to be relatively high, TIVAP implantation using femoral vein access is recommended in patients with bilateral breast cancer not suitable for cephalic vein cut-down.
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Affiliation(s)
- V Almasi-Sperling
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - S Hieber
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - J Lermann
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - O Strahl
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - W Lang
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - T A Sagban
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
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Vidal M, Genillon J, Forestier E, Trouiller S, Pereira B, Mrozek N, Aumeran C, Lesens O. Outcome of totally implantable venous-access port-related infections. Med Mal Infect 2016; 46:32-8. [DOI: 10.1016/j.medmal.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/02/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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11
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Wang TY, Lee KD, Chen PT, Chen MC, Chen YY, Huang CE, Kuan FC, Chen CC, Lu CH. Incidence and risk factors for central venous access port-related infection in Chinese cancer patients. J Formos Med Assoc 2015; 114:1055-60. [PMID: 26253646 DOI: 10.1016/j.jfma.2015.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/PURPOSE Cytotoxic chemotherapy via central venous access ports is an important part of the standard treatment for most cancers, but it is accompanied with the risk of infections. This study aimed to analyze the incidence and risk factors for central venous access port-related infection (CPI) among Chinese patients receiving cytotoxic chemotherapy. METHODS Between January 1, 2002 and December 31, 2005 a total of 1391 cancer patients with 1449 totally implantable central venous access ports were evaluated. The log-rank test and Cox proportional hazards model were used for the analyses of risk factors. RESULTS The overall CPI incidence rate was 0.21 per 1000 catheter-days. Hematological malignancies and head and neck cancer were associated with an increased risk of CPI (hazard ratio 4.00 and 4.11, respectively, both p < 0.001) and less infection-free catheter longevity (p < 0.001) compared with other cancer types. Chemotherapy in an adjuvant setting was associated with a lower risk of infection than for patients in a nonadjuvant setting (p < 0.001). The most common pathogens isolated from CPI were Pseudomonas aeruginosa and Candida. CONCLUSION Infection remains to be a challenging issue for totally implantable central venous ports. Implementation of an insertion bundle for the prevention of central line-associated bloodstream infections is warranted, especially for those patients with hematological and head and neck cancers, as well as for patients receiving chemotherapy in the metastatic settings.
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Affiliation(s)
- Ting-Yao Wang
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Kuan-Der Lee
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Ping-Tsung Chen
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Min-Chi Chen
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Yi-Yang Chen
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Cih-En Huang
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Feng-Che Kuan
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Chih-Cheng Chen
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC
| | - Chang Hsien Lu
- Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital-Chiayi, Puzi City, Taiwan, ROC.
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12
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Delay before implanting a port-a-cath after removing the previous one because of infection. Med Mal Infect 2014; 44:315-20. [DOI: 10.1016/j.medmal.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022]
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13
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Chauhan A, Bernardin A, Mussard W, Kriegel I, Estève M, Ghigo JM, Beloin C, Semetey V. Preventing Biofilm Formation and Associated Occlusion by Biomimetic Glycocalyxlike Polymer in Central Venous Catheters. J Infect Dis 2014; 210:1347-56. [DOI: 10.1093/infdis/jiu249] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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14
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Lebeaux D, Fernández-Hidalgo N, Chauhan A, Lee S, Ghigo JM, Almirante B, Beloin C. Management of infections related to totally implantable venous-access ports: challenges and perspectives. THE LANCET. INFECTIOUS DISEASES 2014; 14:146-59. [DOI: 10.1016/s1473-3099(13)70266-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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15
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Korbila IP, Bliziotis IA, Lawrence KR, Falagas ME. Antibiotic-lock therapy for long-term catheter-related bacteremia: a review of the current evidence. Expert Rev Anti Infect Ther 2014; 5:639-52. [PMID: 17678427 DOI: 10.1586/14787210.5.4.639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality, especially among patients receiving hemodialysis, parenteral nutrition and chemotherapy. Antibiotic-lock therapy (ALT) represents a promising technique in the modern treatment of CRBSIs. In this review, we attempt to clarify the potential role of ALT in the treatment of long-term catheter-related bacteremia, based on the available evidence from published studies reporting on this issue. We identified 28 articles that were considered appropriate to be included in our review, only three of which were comparative studies. There is some evidence that ALT administered concurrently with systemic therapy may represent a significant therapeutic approach for CRBSIs involving long-term catheters. Prolonged infection-free catheter survival in the reported series is suggestive of sterilization of the catheters by ALT. The only reported comparison shows better outcome with ALT than with catheter exchange. Immunodeficient states, such as HIV, and the use of totally implanted devices instead of tunneled catheters may predispose to CRBSI treatment failure. No serious adverse effects, such as emergence of resistance or increased infectious complications, were found to be associated with the use of ALT in the reviewed studies. However, more comparative studies should be performed to examine this important therapeutic issue further.
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Fernández-Hidalgo N, Almirante B. Antibiotic-lock therapy: a clinical viewpoint. Expert Rev Anti Infect Ther 2013; 12:117-29. [PMID: 24308711 DOI: 10.1586/14787210.2014.863148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antibiotic lock therapy (ALT) - instillation of high concentrations of anti-microbial agent with or without anti-coagulant into the lumen of central venous catheters - is considered a valid conservative treatment for catheter-related bloodstream infection (CRBSI) in patients highly dependent on maintaining the catheter. Results from randomized controlled studies have indicated that the effectiveness of ALT is moderate, but recent findings from experimental studies and observational case series point to considerable efficacy and safety of this therapy, which is usually associated with concomitant systemic treatment. In this article, the current knowledge about ALT for patients with CRBSI is reviewed and discussed, with emphasis on existing controversies and the results obtained according to the various uses of the catheters and the etiologies of infection.
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Affiliation(s)
- Nuria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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17
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Low rate of bacteremia with a subcutaneously implanted central venous access device. J Vasc Access 2013; 15:51-5. [PMID: 24101416 DOI: 10.5301/jva.5000178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients at long-term acute care hospitals (LTACs) are medically complex with multiple comorbidities and high rates of antibiotic and device use. The objective of the study was to analyze the incidence and rate of central line-associated bloodstream infections (CLABSI) and the critical factors for patient care, management, placement and maintenance of the implanted central venous access device at this LTAC. METHODS A 13-year retrospective chart review was performed comprising 191 medically complex patients with multiple comorbidities who had an implanted central line port. Information analyzed included (1) number of catheters; (2) number of patients; (3) number of catheter line days; (4) patient demographics; (5) port location; (6) admission diagnoses; (7) type, incidence and rate of catheter-related complications. RESULTS The total number of catheter days was over 183,183 with a mean of 959 catheter days per patient. The mean rate of CLABSI was 0.087 per 1,000 days; incidence was less than 8% of patients with catheters. CONCLUSIONS The study found a markedly lower rate of CLABSI than reported for other LTACs as well as intensive care units, over 14- to 100-fold lower than other LTACs. The authors propose that standardized catheter placement with implementation of rigorous, prospective catheter care plans and a team approach to management were responsible for extremely low complication rates. These results can be extrapolated to different settings across the healthcare continuum.
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Freire MP, Pierrotti LC, Zerati AE, Araújo PHXN, Motta-Leal-Filho JM, Duarte LPG, Ibrahim KY, Souza AAL, Diz MPE, Pereira J, Hoff PM, Abdala E. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors. Infect Control Hosp Epidemiol 2013; 34:671-7. [PMID: 23739070 DOI: 10.1086/671006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. DESIGN Prospective cohort study. SETTING Referral hospital for cancer in São Paulo, Brazil. PATIENTS We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. METHODS Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. RESULTS During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days ([Formula: see text]). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. CONCLUSIONS Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.
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Affiliation(s)
- Maristela P Freire
- Infection Control Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
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Celebi S, Sezgin ME, Cakır D, Baytan B, Demirkaya M, Sevinir B, Bozdemir SE, Gunes AM, Hacimustafaoglu M. Catheter-associated bloodstream infections in pediatric hematology-oncology patients. Pediatr Hematol Oncol 2013; 30:187-94. [PMID: 23458064 DOI: 10.3109/08880018.2013.772683] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.
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Affiliation(s)
- Solmaz Celebi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Uludag University Medical Faculty, Bursa, Turkey.
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20
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Touré A, Vanhems P, Lombard-Bohas C, Cassier P, Péré-Vergé D, Souquet JC, Ecochard R, Chambrier C. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors. Am J Infect Control 2012; 40:935-9. [PMID: 22633131 DOI: 10.1016/j.ajic.2012.01.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/14/2012] [Accepted: 01/17/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Central venous access port-related bloodstream infection (CVAP-BSI) is associated with morbidity and mortality in patients with cancer. This study examined the incidence rates and risk factors for CVAP-BSI in adult patients with digestive cancer. METHODS This prospective observational cohort study was performed from 2007 to 2011 in 2 oncology units of a university hospital. Incidence rate was expressed as number of CVAP-BSI per 1,000 catheter-days. A Cox regression model was used to identify risk factors for CVAP-BSI. RESULTS A total of 315 patients were included. CVAP-BSI occurred in 41 patients (13.0%). The overall incidence rate was 0.76/1,000 catheter-days. The rate was higher in patients with esophageal cancer (1.28. P = .05) and pancreatic cancer (1.24; P = .007). Risk factors independently associated with CVAP-BSI were World Health Organization performance status between 2 and 4, catheter utilization-days in the previous month, pancreatic cancer, and parenteral nutrition. Coagulase-negative Staphylococci and enterobacteria were the main microorganisms isolated. CONCLUSIONS In adult patients with digestive cancer, pancreatic cancer, cumulative catheter utilization-days, World Health Organization performance status, and parenteral nutrition were identified as independent risk factors for CVAP-BSI. Patients with any of these risk factors could be candidates for preventive strategies.
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Affiliation(s)
- Abdoulaye Touré
- INSERM Unit 1060, INRA 1235, Unité de Nutrition Clinique Intensive, 103 Grande Rue de la Croix Rousse, University of Lyon, Lyon, France.
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Lebeaux D, Larroque B, Gellen-Dautremer J, Leflon-Guibout V, Dreyer C, Bialek S, Froissart A, Hentic O, Tessier C, Ruimy R, Pelletier AL, Crestani B, Fournier M, Papo T, Barry B, Zarrouk V, Fantin B. 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. [PMID: 23117849 DOI: 10.1097/md.0b013e318275ffe1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Morbidity and mortality after a totally implantable venous access port (TIVAP)-related infection in oncology patients have rarely been studied. We conducted this study to assess the incidence and factors associated with the following outcome endpoints: severe sepsis or septic shock at presentation, cancellation of antineoplastic chemotherapy, and mortality at week 12. We conducted a prospective single-center observational study including all adult patients with solid cancer who experienced a TIVAP-related infection between February 1, 2009, and October 31, 2010. Patients were prospectively followed for 12 weeks. Among 1728 patients receiving antineoplastic chemotherapy during the inclusion time, 72 had an episode of TIVAP-related infection (4.2%) and were included in the study (median age, 60 yr; range, 28-85 yr). The incidence of complications was 18% for severe sepsis or septic shock (13/72 patients), 30% for definitive cancellation of antineoplastic chemotherapy (14/46 patients who still had active treatment), and 46% for death at week 12 (33/72 patients). Factors associated with severe sepsis or septic shock were an elevated C-reactive protein (CRP) level and an infection caused by Candida species; 4 of the 13 severe episodes (31%) were due to coagulase-negative staphylococci (CoNS). Factors associated with death at week 12 were a low median Karnofsky score, an elevated Charlson comorbidity index, the metastatic evolution of cancer, palliative care, and an elevated CRP level at presentation. Hematogenous complications (that is, infective endocarditis, septic thrombophlebitis, septic pulmonary emboli, spondylodiscitis, septic arthritis, or organ abscesses) were found in 8 patients (11%). In conclusion, patients' overall condition (comorbidities and autonomy) and elevated CRP level were associated with an unfavorable clinical outcome after a TIVAP-related infection. Candida species and CoNS were responsible for severe sepsis or septic shock.
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Affiliation(s)
- David Lebeaux
- From the Service de Médecine Interne (DL, JGD, AF, VZ, BF), Unité d'Epidémiologie et de Recherche Clinique (BL), Service de Microbiologie (VLG, SB),Service d'Oncologie Médicale (CD), Service d'Hépatologie et Gastroentérologie (OH), and Service d'Anesthésie-Réanimation (CT), Hôpital Beaujon, AP-HP, Clichy; and Service de Microbiologie (RR), Service d'Hépatologie etGastroentérologie (ALP), Service de Pneumologie (BC, MF), Service de Médecine Interne (TP), and Service d'Oto-rhino Laryngologie (BB), Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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Newman N, Issa A, Greenberg D, Kapelushnik J, Cohen Z, Leibovitz E. Central venous catheter-associated bloodstream infections. Pediatr Blood Cancer 2012; 59:410-4. [PMID: 22535579 DOI: 10.1002/pbc.24135] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 02/21/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND To investigate the epidemiologic and microbiological aspects of long-term central vein catheter (CVC)-associated bloodstream infections (CABSI) in children <18 years old treated at the hemato-oncology unit during 1998-2008. PATIENTS AND METHODS The two long-term access devices used were Hickman and Port-A-Cath catheters. Information retrieved included demographic data, baseline pathologies, methods of insertion, anatomical insertion sites, duration of use, microbiological, and antibiotic susceptibility data and outcome. RESULTS There were 178 CABSI episodes; average number of episodes/1,000 catheter days was 4.7. More CABSI episodes were recorded among patients with Hickman catheter than in patients with Port-A-Cath catheter (5.05 vs. 3.57/1,000 catheter days, P = 0.059). The CVC was removed due to BSI in 52/178 (29.2%) episodes. Overall, 243 pathogens were isolated (144 Gram-negative, 92 Gram-positive, and 7 Candida spp). More Enterobacteriaceae spp. were isolated in CABSI in patients with Hickman catheters than in patients with Port-A-Cath catheters (35/103, 34%, vs. 10/65, 15%, P = 0.008); more coagulase-negative staphylococci were isolated in patients with Port-A-Cath catheters than in patients with Hickman catheters (25/65, 38.5%, vs. 23/103, 22.3%, P = 0.02). No differences in pathogen distribution were found between CABSI recorded for jugular versus subclavian veins, open versus close inserted-CVC or for CVC requiring removal versus those treated conservatively. No fatalities directly related to CABSI were recorded. CONCLUSIONS CABSI rates were higher in patients with Hickman catheters compared with those with Port-A-Cath catheters; Gram-negative organisms were the dominant etiologic agents of CABSI; CABSI in patients with Hickman catheters had different etiologies compared with patients with Port-A-Cath catheters.
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Affiliation(s)
- Nitza Newman
- Pediatric Surgery Department, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Barbetakis N, Asteriou C, Kleontas A, Tsilikas C. Totally implantable central venous access ports. Analysis of 700 cases. J Surg Oncol 2011; 104:654-6. [DOI: 10.1002/jso.21990] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 05/20/2011] [Indexed: 11/11/2022]
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[Complications of venous port systems : Radiological diagnostics and minimally invasive therapy]. Radiologe 2011; 51:397-402, 404. [PMID: 21523450 DOI: 10.1007/s00117-011-2175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Documentation of a correct port placement is a routine investigation in radiology. This article describes typical complications of port catheters and minimally invasive treatment options which can guarantee further use without complications. MATERIAL AND METHODS From January 2009 to May 2010 a surgical port placement was carried out on 174 patients at the University Clinic in Mannheim and of these, 52 patients were admitted to our institute for radiological imaging of the port. Minimally invasive treatment options are presented based on the observed port complications. RESULTS Of the 52 patients 7 (13.5%) received a port catheter lysis. A successful port position correction was carried out in 3 (5.8%) patients with a malpositioned port catheter and port removal was recommended in 2 patients (3.8%) due to extensive arm venous thrombosis. A minimally invasive port catheter treatment allowed further use of the port system without operative revision in the corresponding patients. The measures were tolerated very well by the patients without postinterventional complications.
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25
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Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy. Med Oncol 2011; 29:1361-4. [DOI: 10.1007/s12032-011-9887-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
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Frequent Accesses to Totally Implanted Vascular Ports in Pediatric Oncology Patients are Associated with Higher Infection Rates. J Vasc Access 2011; 12:207-10. [DOI: 10.5301/jva.2011.6258] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2010] [Indexed: 11/20/2022] Open
Abstract
Purpose Totally implanted vascular (TIVA) ports are used in children for repeated blood samples or intravenous treatments. We have recently published a prospective evaluation of surgical incidents and early complications associated with these devices. This work is the final part of the same study, assessing late complications over a follow-up of 2 yrs. Methods From January 2006 to January 2008, children older than 1 yr of age with a diagnosis of solid or blood cell malignancy were included. Insertion technique and care of the device were standardized. Every manipulation was prospectively recorded by specialized nurses. Obstruction was documented clinically. When bacteremia was suspected, routine central and peripheral blood cultures were drawn. Results Forty-five consecutive patients were enrolled in the study. Mean age at the time of the procedure was 8.5 yrs. There was no catheter-related infection within the first 4 weeks post-surgery. No device had to be removed because of infection or obstruction during follow-up. Frequent accesses to the port (≥3 per day over a 10–day period) were associated with an 8–fold risk of infection. Conclusion Insertion and use of TIVA devices were frequently associated with complications. No device had to be removed because of infection or obstruction over the follow-up period, although no prophylactic antibiotic agent was used. Restrictive use of antibiotics may prevent opportunistic infection. Frequent access to the device was significantly associated with line infection (odds ratio=8.43). No risk factor was identified for obstruction which occurred at a rate of 5.3 per 10,000 accesses.
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Complications infectieuses liées aux chambres implantables : caractéristiques et prise en charge. Rev Med Interne 2010; 31:819-27. [DOI: 10.1016/j.revmed.2010.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 06/14/2010] [Accepted: 06/22/2010] [Indexed: 11/21/2022]
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Pardo I, Rager EL, Bowling MW, Fajardo A, Clare S, Goulet R. Central Venous Port Placement: A Comparison of Axillary Versus Anterior Chest Wall Placement. Ann Surg Oncol 2010; 18:468-71. [DOI: 10.1245/s10434-010-1353-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Indexed: 11/18/2022]
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Girard R, Traullé C, DeSantis N, Espinouse D, Gardes S, Coiffier B. Groshong or implanted catheter infections in ambulatory haematological patients. J Infect Public Health 2010; 3:134-41. [DOI: 10.1016/j.jiph.2010.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 09/16/2009] [Accepted: 05/20/2010] [Indexed: 10/19/2022] Open
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Cortelezzia A, Fracchiolla NS, Maisonneuve P, Moia M, Luchesini C, Ranzi ML, Monni P, Pasquini MC, Lambertenghi-Deliliers G. Central Venous Catheter-related Complications in Patients with Hematological Malignancies: A Retrospective Analysis of Risk Factors and Prophylactic Measures. Leuk Lymphoma 2010; 44:1495-501. [PMID: 14565650 DOI: 10.3109/10428190309178770] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED We retrospectively analyzed the incidence of thrombotic and infectious complications in relation with the use of central venous catheters (CVCs), in a series of patients with hematological malignancies and low platelet and leucocyte counts. PATIENTS AND METHODS 126 patients with hematological malignancies were analyzed. A total of 207 CVCs were implanted: 137 centrally (CICCs) and 70 peripherally (PICCs). The median duration of the CVCs was 19 days for a total of 4051 catheter-days. Antithrombotic prophylaxis was unfractionated heparin (UFH), 2,500 IU daily by 24 h continuous infusion in 169 CVCs, low molecular weight heparin (LMWH), 3,800 IU daily by single bolus intravenous injection (i.v.) in 21 and warfarin in one. No prophylaxis was given in 16 CVCs. Thrombotic complications developed in 15.5% of the CVCs (7.9 events/1000 catheter days), and the frequency of infectious complications was 10.6% (5.2 events/1000 catheter days). On multivariate analysis thromboses were more frequent and earlier with PICCs than CICCs (p = 0.0001), and in patients on UFH (16.6%) than in LMWH prophylaxis (4.7%), but the last difference was not statistically significant. In conclusions the incidence of thrombotic complications in our series was comparable to that observed in non-thrombocytopenic patients and was significantly higher in those carrying PICC than CICC (p = 0.0001). There were fewer thrombotic events in the patients receiving i.v. LMWH prophylaxis than in those receiving i.v. UFH. The use of anticoagulants was safe and not associated with hemorrhages.
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Affiliation(s)
- A Cortelezzia
- Department of Hematology, IRCCS Maggiore Hospital and University of Milan, Milan, Italy.
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Nam SH, Kim DY, Kim SC, Kim IK. Complications and risk factors of infection in pediatric hemato-oncology patients with totally implantable access ports (TIAPs). Pediatr Blood Cancer 2010; 54:546-51. [PMID: 19967773 DOI: 10.1002/pbc.22286] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Totally implantable access ports (TIAPs) are widely used in pediatric hematology-oncology patients. We investigated the incidence of complications, causes of TIAP removal, and risk factors for infection. PROCEDURE We retrospectively analyzed the clinical, demographic, and surgical characteristics in 225 pediatric hematology-oncology patients implanted with 238 TIAPs between January 2004 and December 2005. RESULTS Except for 20 patients lost to follow-up, the mean maintenance period was 724.8 +/- 500.6 days (range: 17-2,124). Mechanical complications occurred in seven patients (2.9%). The causes of TIAP removal were termination of use in 130 patients (59.6%), death from primary disease with TIAP in situ in 35 (14.7%), infection in 35 (14.7%), and obstruction in 4 (1.8%). Early infections occurred in nine patients at mean 37.77 +/- 16.44 days (range: 17-56). Late infections occurred in 26 patients at mean 334.5 +/- 257.82 days (range: 68-997). Univariate analysis showed that the risk factors of early infection were re-implantation (P = 0.022) and long operation time (P = 0.045). The risk factors of late infection were ANC <500/mm(3) (P = 0.011) and platelet count <50,000/mm(3) (P < 0.001). In multivariate analysis, re-implantation was a significant risk factor of early infection (P = 0.033, OR 4.528) and low platelet count (<50,000/mm(3)) was the independent risk factor for late infection (P = 0.005, OR 4.24). CONCLUSIONS Correct procedure and careful use decreases the incidence of early infection and leads to the prevention of re-implantation. Initial thrombocytopenia was attributable to bone marrow suppression caused by hematologic malignancies or severe infection. Thus, this condition is of value in predicting late infection.
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Affiliation(s)
- So-Hyun Nam
- Department of Pediatric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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The impact of antithrombotic prophylaxis on infectious complications in cancer patients with central venous catheters: an observational study. Blood Coagul Fibrinolysis 2009; 20:35-40. [DOI: 10.1097/mbc.0b013e32831bc2f8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liaw CC, Chen JS, Chang HK, Huang JS, Yang TS, Liau CT. Symptoms and signs of port-related infections in oncology patients related to the offending pathogens. Int J Clin Pract 2008; 62:1193-8. [PMID: 18422589 DOI: 10.1111/j.1742-1241.2008.01746.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM There is limited information about symptoms and signs of port-related infections linking to their offending pathogens. METHODS Oncology patients proven to have port-related infections were retrospectively analysed. We divided them into two subgroups according to their symptoms and signs. Onset of fever and chills with or without hypotension following the port flush was classified as 'port flush form infection'. Presence of local inflammatory signs, including erythema, warmth, tenderness and pus formation and systemic infection signs, including fever, chills with or without hypotension was classified as 'local inflammatory form infection'. RESULTS There were 29 episodes of port-related infection among 28 patients, with port flush form 22 episodes and local inflammatory form seven episodes. Of 22 episodes of port flush form infections, 20 (91%) were nosocomial glucose non-fermenting gram-negative bacilli, with Acinetobacter baumannii (11 episodes, 50%) and Enterobacter cloacae (four episodes, 18%) the most common. Polymicrobial infections occurred in four episodes (18%). Candida infection occurred in two episodes (9%). Of seven episodes of local inflammatory form infections, six (86%) were gram-positive cocci, with Staphylococcus aureus (five episodes, 71%) the most common. The time from port implantation to its infection was 272 +/- 255 days (30-993 days) for the port flush form infections and 82 +/- 87 days (22-265 days) for the local inflammatory form infections. This difference was not significant difference (p = 0.068). CONCLUSIONS The differences between infection of patients with port flush form and local inflammatory form in incidence and offending microorganism suggest that the aetiology of infection were different.
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Affiliation(s)
- C-C Liaw
- Division of Hemato-Oncology, Department of Internal Medicine, Chang-Gung Memorial Hospital and Chang-Gung University, Taipei, Taiwan
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Allen RC, Holdsworth MT, Johnson CA, Chavez CM, Heideman RL, Overturf G, Lemon D, Hunt WC, Winter SS. Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer 2008; 51:53-8. [PMID: 18266227 DOI: 10.1002/pbc.21497] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Catheter-associated blood stream infections (CABSI) are frequent complications encountered with cancer treatment. In order to understand which factors might predispose to CABSIs in children and young adults, we evaluated risk for infection in association with tumor type, catheter type, and setting of occurrence. METHODS All pediatric oncology patients having a central venous catheter (CVC) with a tunneled external (TE) or totally implantable design (TID) were prospectively followed for the occurrence of a CABSI for 12 months. CABSIs were defined in accordance with the guidelines published by the Centers for Disease Control, and were quantified as the number of occurrences per 1,000 device days. Rates of CABSIs were stratified by tumor histology, type of catheter design, and setting of occurrence. Statistical comparisons were made using the Mantel-Haenzel statistic and the Cox proportional hazard model. RESULTS A total of 58 CABSIs were identified in 139 patients over a period of 35,935 CVC days. The overall CABSI rate was 1.6 infections per 1,000 CVC days (95% CI 1.2, 2.1). Stratified analysis demonstrated increased risk for CABSIs in hospitalized patients having TEs, and while patients with solid tumors were also at higher risk; this association was not supported by the Cox proportional hazard model. CONCLUSION While our baseline CABSI rate was comparatively lower than for other institutions, subset analyses identified that hospitalized cancer patients having TEs are at the highest risk for developing CABSIs. Our findings may help to guide improved methods of anticipating and controlling infections in immunocompromised patients.
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Affiliation(s)
- Rebekah C Allen
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Souza Dias MB, Habert AB, Borrasca V, Stempliuk V, Ciolli A, Araújo MRE, Costa SF, Levin AS. Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution. Infect Control Hosp Epidemiol 2008; 29:125-30. [PMID: 18179367 DOI: 10.1086/526440] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe the management of patients with long-term central venous catheters (CVCs) during an outbreak of infection due to Pseudomonas putida and Stenotrophomonas maltophilia associated with contaminated heparin catheter-lock solution. DESIGN Descriptive study. SETTING Private, 250-bed tertiary-care hospital. METHODS In March 2003, we identified 2 febrile cancer patients with P. putida bacteremia. Over 2 days, 7 cases of bacteremia were identified; lots of syringes prefilled with heparin catheter-lock solution, supplied by a compounding pharmacy, were recalled and samples were cultured. More cases of bacteremia appeared during the following days, and any patient who had had a catheter lock infused with the suspect solution was asked to provide blood samples for culture, even if the patient was asymptomatic. Isolates that were recovered from culture were typed by pulsed-field gel electrophoresis. Antimicrobial salvage treatment of long-term CVCs was attempted. RESULTS A total of 154 patients had had their catheter lock infused with solution from the lots that were suspected of being contaminated. Only 48 of these patients had CVCs. By day 7 of the outbreak, 18 of these patients had become symptomatic. Twenty-six of the remaining 30 asymptomatic patients then also provided blood samples for culture, 10 of whom developed fever shortly after samples were collected. Thirty-two patients were identified who had P. putida bacteremia; 9 also had infection due to S. maltophilia. Samples from 1 of the 3 lots of prefilled syringes in use at the time of the outbreak also grew P. putida on culture. Molecular typing identified 3 different clones of P. putida from patients and heparin catheter-lock solution, and 1 clone of S. maltophilia. A total of 27 patients received antimicrobial therapy regimens, some of which included decontamination of the catheter lock with anti-infective lock solution. Of 27 patients, 19 (70%) retained their long-term CVC during the 6-month follow-up period. CONCLUSIONS To our knowledge, this is one of the largest prospective experiences in the management of bloodstream infection associated with long-term CVCs. The infections were caused by gram-negative bacilli and were managed without catheter removal, with a high response rate. We emphasize the risks of using intravenous formulations of medications supplied by compounding pharmacies that produce large quantities of drugs.
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Affiliation(s)
- M Beatriz Souza Dias
- Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
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Unamuno MDRDLD, Carneiro JJ, Chueire FB, Marchini JS, Suen VMM. Uso de cateteres venosos totalmente implantados para nutrição parenteral: cuidados, tempo de permanência e ocorrência de complicações infecciosas. REV NUTR 2005. [DOI: 10.1590/s1415-52732005000200010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cateteres venosos totalmente implantados são utilizados em pacientes com síndrome do intestino curto, para realizar o suporte nutricional parenteral, o qual mantém estes pacientes vivos, pois fornece-lhes nutrientes que são absorvidos pela via digestiva. No entanto, estes cateteres não são isentos de complicações. As infecções relacionadas aos cateteres venosos são as complicações mais temidas e sua incidência varia de 3% a 20%, aumentando em pacientes mais graves. O objetivo do presente estudo é descrever as complicações infecciosas em pacientes recebendo nutrição parenteral por meio de cateteres venosos totalmente implantados. Tais cateteres são utilizados pela Divisão de Nutrição Clínica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, para realizar o suporte nutricional parenteral em pacientes submetidos a ressecções extensas de intestino delgado. Foram avaliadas as complicações infecciosas ocorridas com 21 cateteres, implantados em 16 pacientes. O tempo de permanência dos cateteres foi de 768±664,3 dias (mediana 529 dias) e a taxa de infecção foi de 0,029 infecções/paciente/ano, resultados que se comparam às taxas de infecção observadas em países desenvolvidos. Concluiu-se que os cuidados observados no manuseio destes cateteres foram de fundamental importância para diminuir a incidência de infecção nestes pacientes.
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Wagner SC, Eschelman DJ, Gonsalves CF, Bonn J, Sullivan KL. Infectious complications of implantable venous access devices in patients with sickle cell disease. J Vasc Interv Radiol 2004; 15:375-8. [PMID: 15064341 DOI: 10.1097/01.rvi.0000121410.46920.6e] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the incidence of implantable venous access device infection in patients with sickle cell disease. MATERIALS AND METHODS The authors performed a retrospective search of their hospital's information system from January 1, 1996 to December 31, 2001 to identify hospital admissions with ICD-9 codes related to sickle cell anemia. This search yielded 2703 admissions in 293 patients. A search of the radiology information system identified 23 of these patients who had placement of an implantable venous access device. Excluding two patients who were lost to follow-up, the population of this study included eight men and 13 women aged 23 to 62 years old (mean, 37 years). A total of 30 implantable venous access devices (25 venous ports, five tunneled catheters) were placed by interventional radiologists. Cases of device infection were identified based on clinical data, microbiology, reports of device removal, and clinical follow-up. Infections were defined according to the Centers for Disease Control criteria for catheter-related bloodstream infection. The incidence of infection, organism, and time from device placement to infection was determined. RESULTS In 21 patients with 30 devices, 18 device infections (60%) occurred in 12 patients (57%) involving 15 venous ports and three tunneled catheters. There were a total of 12389 days of catheter use and a rate of 1.5 infections per 1000 catheter days. Infections occurred from 16 to 1542 days (mean, 349 days) after device placement. Blood, wound, and catheter tip cultures yielded solitary organisms in 13 cases and mixed organisms in four cases. Staphylococcus aureus was the most common pathogen (59%). One patient was considered infected based on clinical signs and purulent discharge from the port site, despite negative cultures after partial antibiotic treatment. One patient died of sepsis resulting from an infected port. CONCLUSION This study shows a high incidence of infection associated with placement of implantable venous access devices in patients with sickle cell disease. Therefore, the authors avoid placing these devices in this patient population.
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Affiliation(s)
- Steven C Wagner
- Division of Cardiovascular and Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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Wolosker N, Yazbek G, Nishinari K, Malavolta LC, Munia MA, Langer M, Zerati AE. Totally implantable venous catheters for chemotherapy: experience in 500 patients. SAO PAULO MED J 2004; 122:147-51. [PMID: 15543368 DOI: 10.1590/s1516-31802004000400003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY Prospective. SETTING Hospital do Cancer A.C. Camargo, Sao Paulo, Brazil. METHODS 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2%) catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use), 11 obstructions (0.06/1000 days of catheter use) and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use). Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.
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Affiliation(s)
- Nelson Wolosker
- Hospital do Câncer, Fundação A. C. Camargo, São Paulo, Brazil.
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Abstract
Infection represents one of the most common venous access device (VAD)-related complications requiring catheter removal. Recognition of such complications is essential to provide appropriate therapy in the setting of active infection. This article reviews the definition of various types of infections, as well as reviewing the diagnosis, prevention, and treatment of VAD-related infections.
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Affiliation(s)
- Charles E Ray
- Division of Interventional Radiology, Denver Health Medical Center, and the Department of Radiology, University of Colorado Health Sciences Center, Denver 80207, USA
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Weinstock DM, Rogers M, Eagan J, Malak SA, Sepkowitz KA. Nosocomial central venous catheter infections among patients with different types of cancer. Infect Control Hosp Epidemiol 2002; 23:234-5. [PMID: 12026145 DOI: 10.1086/503461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bernard P, Vrignaud S, Letessier E, Denimal F, Le Néel JC. [Abnormal catheter mobility in a totally implantable venous access depending on the upright or supine position in an obese patient]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:720-2. [PMID: 11695292 DOI: 10.1016/s0750-7658(01)00461-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The authors advise on an exceptional complication in a totally implantable venous access and give recommendations on how to avoid this problem. In an obese person, one week after the implantation of a totally implantable venous access, a chest X-ray showed that the catheter was too short. In the operative room, at the time of the second intervention, the radioscopy did not find this anomaly. The subcutaneous injection port was positioned too low. When the patient was in a supine position, the subcutaneous injection port was in the correct position but when she was in an upright position, the breast descended and pulled down the subcutaneous injection port and the catheter.
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Affiliation(s)
- P Bernard
- Clinique chirurgicale A, CHU, Hôtel-Dieu, 44093 Nantes, France.
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Roberts AC. Venous Access Catheter Complications. J Vasc Interv Radiol 2001. [DOI: 10.1016/s1051-0443(01)70035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Aitken ML, Tonelli MR. Complications of indwelling catheters in cystic fibrosis: a 10-year review. Chest 2000; 118:1598-602. [PMID: 11115445 DOI: 10.1378/chest.118.6.1598] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE Patients with cystic fibrosis (CF) frequently require recurrent courses of IV antibiotics to treat acute exacerbations of their pulmonary disease. Over time, CF patients often lose peripheral access, and indwelling central venous catheters are placed. We attempted to determine the type and incidence of catheter complications so that CF patients could be fully informed of the risks prior to placement of these catheters. DESIGN The charts of all CF patients who attended the Adult Cystic Fibrosis Clinic of the University of Washington Medical Center from January 1989 through December 1998 were reviewed. Demographic information was obtained along with the type and duration of catheter, type and number of complications, and the use of anticoagulant medication. MEASUREMENTS AND RESULTS Of the 218 CF patients who attended the clinic, 65 patients (30%) had indwelling catheters in place at some time during the study period. A total of 87 catheters were placed into these 65 patients. The total number of catheter-days for first indwelling catheters was 68,220. The total number of catheter-days for all catheters was 75,660 (210 catheter-years). Thirty-five catheter-related complications were identified, occurring in 26 patients. Complications included thrombosis (n = 14), infections (n = 9), mechanical problems (n = 6), pneumothorax (n = 3), superior vena cava syndrome/stenosis (n = 2), and air embolism (n = 1), for an overall complication rate of 0. 463/1,000 catheter-days. CONCLUSION We conclude that indwelling catheters are relatively safe in patients with CF. Good infection control policies appear to prevent most infectious complications. The most common complication is that of thrombosis, which may be recurrent in some patients. Consideration should be given to prophylactic warfarin therapy despite the potential risk of significant hemoptysis in this patient population.
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Affiliation(s)
- M L Aitken
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle 98195, USA.
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