Cancer Res Treat.  2014 Jul;46(3):250-260.

A Case-Control Study to Identify Risk Factors for Totally Implantable Central Venous Port-Related Bloodstream Infection

Affiliations
  • 1Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. jinkang@catholic.ac.kr
  • 2Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 3Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To date, the risk factors for central venous port-related bloodstream infection (CVP-BSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer.
MATERIALS AND METHODS
A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time.
RESULTS
CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047).
CONCLUSION
In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted.

Keyword

Neoplasms; Catheter-related infections; Risk factors

MeSH Terms

Case-Control Studies*
Catheter-Related Infections
Catheters
Drug Therapy
Fungi
Gastrointestinal Neoplasms
Gram-Positive Cocci
Humans
Mortality
Multivariate Analysis
Risk Factors*

Figure

  • Fig. 1. Factors, initial disease status (A) and monthly catheter-stay duration (B), affecting on catheter life span by Kaplan-Meier analysis.


Reference

References

1. Gyves JW, Ensminger WD, Niederhuber JE, Dent T, Walker S, Gilbertson S, et al. A totally implanted injection port system for blood sampling and chemotherapy administration. JAMA. 1984; 251:2538–41.
Article
2. Wolosker N, Yazbek G, Nishinari K, Malavolta LC, Munia MA, Langer M, et al. Totally implantable venous catheters for chemotherapy: experience in 500 patients. Sao Paulo Med J. 2004; 122:147–51.
Article
3. Ng F, Mastoroudes H, Paul E, Davies N, Tibballs J, Hochhauser D, et al. A comparison of Hickman line- and Port-a-Cath-associated complications in patients with solid tumours undergoing chemotherapy. Clin Oncol (R Coll Radiol). 2007; 19:551–6.
Article
4. Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA Cancer J Clin. 2008; 58:323–46.
Article
5. Kim JT, Oh TY, Chang WH, Jeong YK. Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy. Med Oncol. 2012; 29:1361–4.
Article
6. Cortelezzia A, Fracchiolla NS, Maisonneuve P, Moia M, Luchesini C, Ranzi ML, et al. Central venous catheter-related complications in patients with hematological malignancies: a retrospective analysis of risk factors and prophylactic measures. Leuk Lymphoma. 2003; 44:1495–501.
7. Raad I, Hachem R, Hanna H, Bahna P, Chatzinikolaou I, Fang X, et al. Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis. 2007; 26:549–56.
Article
8. Tacconelli E, Smith G, Hieke K, Lafuma A, Bastide P. Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. J Hosp Infect. 2009; 72:97–103.
Article
9. Tong EN, Clements AC, Haynes MA, Jones MA, Morton AP, Whitby M. Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study. BMC Infect Dis. 2009; 9:145.
Article
10. Worth LJ, Slavin MA, Brown GV, Black J. Catheter-related bloodstream infections in hematology: time for standardized surveillance? Cancer. 2007; 109:1215–26.
11. Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, et al. Infectious morbidity associated with longterm use of venous access devices in patients with cancer. Ann Intern Med. 1993; 119:1168–74.
Article
12. Hsieh CC, Weng HH, Huang WS, Wang WK, Kao CL, Lu MS, et al. Analysis of risk factors for central venous port failure in cancer patients. World J Gastroenterol. 2009; 15:4709–14.
Article
13. Mollee P, Jones M, Stackelroth J, van Kuilenburg R, Joubert W, Faoagali J, et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect. 2011; 78:26–30.
Article
14. Toure A, Vanhems P, Lombard-Bohas C, Cassier P, Pere-Verge D, Souquet JC, et al. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors. Am J Infect Control. 2012; 40:935–9.
15. Tomlinson D, Mermel LA, Ethier MC, Matlow A, Gillmeister B, Sung L. Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis. 2011; 53:697–710.
Article
16. Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997; 127(8 Pt 2):757–63.
Article
17. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp In. 2007; 65 Suppl 1:S1–64.
Article
18. Howell PB, Walters PE, Donowitz GR, Farr BM. Risk factors for infection of adult patients with cancer who have tunnelled central venous catheters. Cancer. 1995; 75:1367–75.
Article
19. Kim HJ, Yun J, Kim HJ, Kim KH, Kim SH, Lee SC, et al. Safety and effectiveness of central venous catheterization in patients with cancer: prospective observational study. J Korean Med Sci. 2010; 25:1748–53.
Article
20. Bennett CL, Djulbegovic B, Norris LB, Armitage JO. Colonystimulating factors for febrile neutropenia during cancer therapy. N Engl J Med. 2013; 368:1131–9.
Article
21. Dompeling EC, Donnelly JP, Deresinski SC, Feld R, Lane-Allman EF, De Pauw BE. Early identification of neutropenic patients at risk of grampositive bacteraemia and the impact of empirical administration of vancomycin. Eur J Cancer. 1996; 32A:1332–9.
Article
22. Pizzo PA. Fever in immunocompromised patients. N Engl J Med. 1999; 341:893–900.
Article
23. Blijlevens NM, Donnelly JP, de Pauw MR. Empirical therapy of febrile neutropenic patients with mucositis: challenge of risk-based therapy. Clin Microbiol Infect. 2001; 7 Suppl 4:47–52.
Article
24. Opelz G, Sengar DP, Mickey MR, Terasaki PI. Effect of blood transfusions on subsequent kidney transplants. Transplant Proc. 1973; 5:253–9.
25. Innerhofer P, Klingler A, Klimmer C, Fries D, Nussbaumer W. Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty. Transfusion. 2005; 45:103–10.
Article
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