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Mu C, Zhu Z, Miao D, Wu Q, Chen L, Jin Y. Clinical efficacy and safety of a new single-incision axillary vein puncture technique for totally implantable venous access ports. Sci Rep 2025; 15:7281. [PMID: 40025108 PMCID: PMC11873167 DOI: 10.1038/s41598-025-91827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 02/24/2025] [Indexed: 03/04/2025] Open
Abstract
To assess the clinical efficacy of a new single-incision axillary vein puncture technique for implanting totally implantable venous access ports (TIVAPs). A retrospective review of patient data from January 2023 to June 2023 at The Affiliated Suzhou Hospital of Nanjing Medical University was conducted. The study included adult patients with solid malignancies scheduled for intravenous chemotherapy and TIVAPs implantation. Patients were categorized into single-incision group (Group S) and dual-incision group (Group D) based on different venous access approaches. Baseline information, primary tumors, immediate adverse events, indwelling time, and early and late adverse events were collected. A total of 338 patients were included in the analysis, with 117 in Group S. and 221 in Group D. Baseline characteristics were comparable between the groups. The technical success rate was 99.1% in Group S and 98.6% in Group D, demonstrating similarity. The mean operative time was 26 min in Group S, significantly shorter than the 36 min in Group D (p < 0.05). Group D experienced more occurrences of localised ecchymosis and painful. Overall, Group S exhibited superiority over Group D in terms of immediate adverse events (p < 0.05). Follow-up data revealed comparable adverse events rates between the two groups. In conclusion, the study indicates that the single-incision axillary vein puncture technique can be safely implemented by an experienced team with a low incidence of adverse events. This approach can serve as a valuable alternative for clinical TIVAPs placement.
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Affiliation(s)
- Chongjing Mu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Gusu District, Suzhou, 215000, China
| | - Zhigang Zhu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Gusu District, Suzhou, 215000, China
| | - Dongliu Miao
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Gusu District, Suzhou, 215000, China
| | - Qiong Wu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Gusu District, Suzhou, 215000, China
| | - Lei Chen
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Gusu District, Suzhou, 215000, China.
| | - Yiqi Jin
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Gusu District, Suzhou, 215000, China.
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Wang F, Zhu Y, Wang L, Huang C, Mei R, Deng LE, Yang X, Xu Y, Zhang L, Xu M. Machine learning risk prediction model for bloodstream infections related to totally implantable venous access ports in patients with cancer. Asia Pac J Oncol Nurs 2024; 11:100546. [PMID: 39148936 PMCID: PMC11324827 DOI: 10.1016/j.apjon.2024.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/19/2024] [Indexed: 08/17/2024] Open
Abstract
Objective This study aimed to develop and validate a machine learning-based risk prediction model for catheter-related bloodstream infection (CRBSI) following implantation of totally implantable venous access ports (TIVAPs) in patients. Methods A retrospective cohort study design was employed, utilizing the R software package mlr3. Various algorithms including logistic regression, naive Bayes, K nearest neighbor, classification tree, and random forest were applied. Addressing class imbalance, benchmarks were used, and model performance was assessed using the area under the curve (AUC). The final model, chosen for its superior performance, was interpreted using variable importance scores. Additionally, a nomogram was developed to calculate individualized risk probabilities, enhancing clinical utility. Results The study involved 755 patients across both development and validation cohorts, with a TIVAP-CRBSI rate of 14.17%. The random forest model demonstrated the highest discrimination ability, achieving a validated AUC of 0.94, which was consistent in the validation cohort. Conclusions This study successfully developed a robust predictive model for TIVAP-CRBSI risk post-implantation. Implementation of this model may aid healthcare providers in making informed decisions, thereby potentially improving patient outcomes.
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Affiliation(s)
- Fan Wang
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanyi Zhu
- Radiotherapy Department, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lijuan Wang
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Caiying Huang
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ranran Mei
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Li-E Deng
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiulan Yang
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yan Xu
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lingling Zhang
- Outpatient Department, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
| | - Min Xu
- Breast Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China
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Kozlowski KM, Jalaeian H, Travis LM, Zikria JF. A comparative analysis of infection and complication rates between single- and double-lumen ports. Infect Control Hosp Epidemiol 2024; 45:698-702. [PMID: 38272652 DOI: 10.1017/ice.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Port-a-caths are implanted intravascular chest ports that enable venous access. With more port placements performed by interventional radiologists, it is important to discern differences in infection and complication rates between double- and single-lumen ports. METHODS We retrospectively reviewed 1,385 port placements over 2 years at the University of Miami. Patients were grouped by single- or double-lumen ports. Data on duration of catheter stay, bloodstream infections, malfunctions, and other complications (fibrin sheath, thrombosis, catheter malposition) were collected. Multivariate Cox regression was performed to identify variables predicting port infection. RESULTS The mean patient age was 58.8 years; the mean BMI was 26.9 kg/m2; and 61.5% of these patients were female. Our search revealed 791 double-lumen ports (57.1%) and 594 single-lumen ports (42.9%). The median follow-up was 668 days (range, 2-1,297). Double-lumen ports were associated with significantly higher rates of bacteremia (2.78% vs 0.84%; P = .02), port malfunction (8.3% vs 2.0%; P < .001), fibrin sheath formation (2.2% vs 0.5%; P < .02), catheter tip malposition (1.0% vs 0; P = .01), and catheter-associated thrombosis (1.4% vs 0; P = .003). Multivariate Cox regression analysis, after adjusting for other variables, showed that double-lumen chest ports had 2.98 times (95% confidence interval, 1.12-7.94) the hazard rate of single-lumen ports for developing bloodstream infection (P = .029). CONCLUSIONS Double-lumen chest ports are associated with increased risk for bloodstream infection, malfunction, fibrin sheath formation, catheter tip malposition, and catheter-associated thrombosis. Interventional radiologists may consider placing single-lumen ports if clinically feasible; however, future studies are needed to determine clinical significance. The study limitations included the retrospective study design and the potential loss of patient follow-up.
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Affiliation(s)
- Konrad M Kozlowski
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Levi M Travis
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Joseph F Zikria
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Jahns F, Hausen A, Keller P, Stolz V, Kalff JC, Kuetting D, von Websky MW. Life on the line - Incidence and management of central venous catheter complications in intestinal failure. Clin Nutr 2024; 43:1627-1634. [PMID: 38772069 DOI: 10.1016/j.clnu.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/04/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Loss of venous access is threatening for patients with intestinal failure (IF) under long-term parenteral nutrition (PN). We aimed to identify the incidence of central venous catheter (CVC) complications, compare different devices, and analyze interventional recanalizing procedures to restore the patency of occluded CVCs. METHODS For this retrospective cohort study, patient data from a prospective IF database spanning 16 years was analyzed at a tertiary referral center. Catheter dwell times (CDTs) were distinguished by Kaplan-Meier survival analysis and subgroup analyses were performed for different CVC types (tunneled/port catheters). Specific complications (occlusion, catheter-related infection (CRI), displacement, and material defect) were analyzed. Explantation rates and CDTs were compared. RESULTS Overall, 193 CVCs in 77 patients with IF under PN could be enrolled (62.524 "CVC-days"). Broviac type "B" was found to be significantly superior to type "A" regarding occlusion, CRI, and material defects (log-rank test: p = 0.05; p = 0.026; p = 0.005 respectively). Port catheters were displaying the highest incidence of CRI (2.13 events/1000 catheter days). Interventional catheter recanalization was performed 91 times and significantly increased the CDT from a median of 131 days (IQR: 62; 258) to 389 days (IQR: 262; 731) (Mann-Whitney-U-test: p= <0.001) without increasing complications. CONCLUSIONS Different complication rates and CDT were seen depending on CVC type. Tunneled catheters were significantly superior concerning CRI. Interventional catheter recanalization is a viable alternative to fibrinolytics to restore CVC patency, but long-term patency data is scarce.
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Affiliation(s)
- Franziska Jahns
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Annekristin Hausen
- Department of Internal Medicine, University Hospital of Bonn, Bonn, Germany
| | - Peter Keller
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Verena Stolz
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - Martin W von Websky
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany.
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Lu MS, Chen CC, Chang CC, Lin CC, Hsieh CC. Risk Factors for Unplanned Early Implantable Port Catheter Removal in Adult Hematology Cancer Patients Receiving Chemotherapy: A Propensity Score Matching Study. Cancer Manag Res 2024; 16:445-454. [PMID: 38736587 PMCID: PMC11088845 DOI: 10.2147/cmar.s454063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Implantable port catheter is a reliable vascular access for chemotherapy infusion in cancer patients. However, patients with hematology malignancies usually present with a myriad of blood cell abnormalities that put them at risk of infection and mechanical problems requiring catheter removal. This study aims to determine the risk factors associated with unplanned (catheter removal other than completion of treatment plan) early (within 90 days of catheter implantation) implantable port catheter removal. Patients and Methods A retrospective, propensity score-matched study of 386 patients with hematology malignancies who received implantable venous access ports between January 2015 and December 2022. We conducted a univariate analysis to select the variables for propensity score matching. Patients with unplanned early implantable port catheter removal (early group) were matched 1:1 to patients without unplanned early removal (non-early group). Results Univariate analysis demonstrated a statistically significant difference between early and non-early groups for age (p = 0.048), hemoglobin level (p = 0.028), thrombocytopenia (p = 0.025), and PG-SGA (p < 0.001). Thrombocytopenia was the only independent risk factor with a statistically significant difference in Cox proportional hazard analysis, HR 2.823, 95 CI 1.050-7.589, p = 0.040. The median catheter survival for patients with thrombocytopenia was 61 days (95% CI 28.58-93.42) compared to 150 days (95% CI 9.81-290.19) for patients without thrombocytopenia, p = 0.015. Patient survival is not affected by early catheter removal. The median survival for patients in the early group was 28.28 months (95% CI 27.43-29.15) compared to 32.39 months (95% CI 24.11-40.68), for the non-early group, p = 0.709. Conclusion Hematology malignancy patients with thrombocytopenia are at high risk for unplanned early port catheter removal without survival difference.
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Affiliation(s)
- Ming-Shian Lu
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chen Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medicine, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Che-Chia Chang
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Chien-Chao Lin
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Ching-Chuan Hsieh
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Sharma V, Pandey A. A Spectrum of Chemoport-Associated Complications and Their Management in Cancer Patients. Cureus 2024; 16:e58052. [PMID: 38738137 PMCID: PMC11088396 DOI: 10.7759/cureus.58052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly. METHODS We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records. RESULTS The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases. CONCLUSION Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.
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Affiliation(s)
- Vikas Sharma
- Surgical Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Arun Pandey
- Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, IND
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Suzuki T, Michimoto K, Hasumi J, Kisaki S, Hasegawa Y, Fujimori A, Yoshimatsu L, Ashida H, Ojiri H. Silver-Mixed Port Reduces Venous Access Port Related Infection Rate Compared to Non-Silver-mixed Port: A Single-center Retrospective Analysis. Cardiovasc Intervent Radiol 2023; 46:1696-1702. [PMID: 37902854 PMCID: PMC10695883 DOI: 10.1007/s00270-023-03583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Totally implantable venous access ports (TIVAPs) are increasingly used as safe and convenient central venous access devices. However, several TIVAP-related complications occur, with port/catheter infection being most common. Silver-mixed ports have recently been introduced in anticipation of reducing TIVAP infection. This study aimed to investigate the efficacy of this device in reducing port infection by examining groups with and without silver-mixed devices. MATERIALS AND METHODS From April 2017 to July 2022, silver-mixed ports (S group) and non-silver-mixed port group (NS group) were reviewed at our institution. The incidence of TIVAP-related infections, patient characteristics, and bacteriological data were evaluated. Univariate and multivariate analyses were used to evaluate risk factors for TIVAP-related infection. RESULTS A total of 607 patients (S group, n = 203; NS group, n = 404) were enrolled. The rates of TIVAP-related infection were 3.0% (n = 6) and 7.7% (n = 31) in the S and NS groups, respectively. The incidence of total infection per 1000 catheter-days were 0.114 and 0.214 the S and NS groups, respectively. In the entire group, the rates of infection were 6.1% (n = 37) and the incidence of total infection per 1000 catheter-days was 0.187. Univariate and multivariate analyses revealed a significantly lower TIVAP-related infection rate in S group than NS group (p = 0.0216, odds ratio = 2.88 confidence interval: 1.17-7.08). No gram-negative rods were detected in the S group as port infection. CONCLUSION Silver-mixed port may be feasible in preventing port infection. LEVEL OF EVIDENCE Level 3, Local non-random sample.
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Affiliation(s)
- Takayuki Suzuki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Kenkichi Michimoto
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Yasuaki Hasegawa
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Ayako Fujimori
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Lynn Yoshimatsu
- Department of Radiology, The Jikei University Daisan Hospital, 4-11-1, Izumihonchou, Komae-shi, Tokyo, 201-8601, Japan
| | - Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
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Bailleul A, Fulgencio JP, Vimont S, Mordelet C, Ray B, Lassel L, Lapidus N, Quesnel C, Garnier M. Risk factors and prognostic significance of infection of totally implantable vascular access port in solid tumor patients: A prospective cohort study. Infect Dis Now 2023; 53:104766. [PMID: 37543258 DOI: 10.1016/j.idnow.2023.104766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Totally implantable venous access ports (TIVAP) are devices mainly used to deliver antineoplastic chemotherapies, of which the insertion may be complicated by TIVAP-related infection (TIVAP-RI). This study aims to provide data on the risk factors for TIVAP-RI and its influence on patient prognosis. PATIENTS AND METHODS Prospective observational study including adult patients with solid tumors, in whom a TIVAP was inserted to deliver antineoplastic chemotherapy between January 2018 and October 2019. Factors associated with TIVAP-RI and one-year mortality were determined using multiple logistic regressions. RESULTS More than a thousand (1014) patients were included, among whom 48 (4.7%) presented with TIVAP-RI. Gram-positive cocci and Gram-negative bacilli represented 51% and 41% of the pathogens isolated, respectively. Young age (odds ratio [OR] 0.67; 95% Confidence Interval [0.53-0.83] per 10-year increase), WHO performance status ≥ 1 (OR 3.24 [1.52-7.79]), chemotherapy administration in the month before TIVAP placement (OR 2.26 [1.17-4.26]), and radiation therapy of the homolateral chest wall (OR 3.28 [1.51-6.67]) were independently associated with TIVAP-RI occurrence. During the year following TIVAP insertion, 287 (28%) patients died. TIVAP-RI was not associated with one-year mortality (OR 1.56 [0.75-3.19]). CONCLUSION TIVAP insertion in adult patients with solid tumors is associated with a low infection rate, which did not influence one-year mortality. In addition to young age and impaired health status, TIVAP insertion in the month following initiation of the antineoplastic chemotherapy and TIVAP insertion in an irradiated area are two newly reported preventable TIVAP-RI risk factors.
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Affiliation(s)
- Amaury Bailleul
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Jean-Pierre Fulgencio
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Sophie Vimont
- Département de Bactériologie, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, - 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne Université, INSERM UMR S_1155, Hôpital Tenon, Paris, France
| | - Cécile Mordelet
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Benoit Ray
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Ludovic Lassel
- Sorbonne Université, AP-HP, DMU 3ID, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales - 4 rue de la Chine, 75020 Paris, France
| | - Nathanaël Lapidus
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, 75012 Paris, France
| | - Christophe Quesnel
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France; Université Clermont-Auvergne, CHU de Clermont-Ferrand, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
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Graf S, Feldmann H, Hunold LS, Steinkraus KC, Nasir N, Michalski CW, Dörr-Harim C, Hüttner FJ. Use of virtual reality in port implantation to reduce perioperative anxiety and pain: protocol for a randomised controlled pilot trial at a single German university hospital (VIP-trial; DRKS00028508). BMJ Open 2023; 13:e074738. [PMID: 37709332 PMCID: PMC10503368 DOI: 10.1136/bmjopen-2023-074738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Intravenous access port implantation is commonly performed under local anaesthesia, which offers advantages such as increased patient satisfaction and resource savings compared with general anaesthesia. However, patients may experience increased perioperative stress and anxiety in the operating room setting without general anaesthesia. Virtual reality (VR) distraction or hypnosis during surgery under local anaesthesia may help patients to auditorily and visually separate from their real environment and engage with a virtual environment through hypnorelaxing guidance. Previous studies suggested that VR hypnosedation may reduce the use of sedatives or general anaesthesia, and may offer additional benefits such as reducing postoperative pain and nausea, and promoting faster patient discharge. METHODS AND ANALYSIS The VIP trial is a randomised controlled pilot trial comparing the usage of VR during port implantation with the current standard of care (local anaesthesia and analgosedation if needed). A total of 120 adult patients are included after screening for eligibility and obtaining informed consent. Patients are randomised preoperatively in a 1:1 ratio to the trial groups. The main outcomes are change of perioperative anxiety and pain. Further outcomes include patient satisfaction and tolerability, perioperative analgesia and sedation, occurrence of postoperative nausea, vomiting and VR sickness symptoms, surgeon's satisfaction, procedure duration, postoperative complications until postoperative day 30 and patient willingness to hypothetically undergo port implantation again under the same conditions. ETHICS AND DISSEMINATION The VIP trial has been approved by the Ethics Committee of the Medical Faculty of Ulm University (reference number 03/22). If the intervention demonstrates that VR can effectively reduce perioperative anxiety and pain, it may become a novel standard of care to minimise the need for analgosedation or general anaesthesia in port implantation procedures and improve patient outcomes. The results will be submitted to a peer-reviewed journal in the field and will be presented at applicable conferences to ensure rigorous evaluation and access for the academic community. TRIAL REGISTRATION NUMBER German Clinical Trials Register: DRKS00028508; registration date 15 March 2022; Universal Trial Number: U1111-1275-4995.
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Affiliation(s)
- Sandra Graf
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Hannah Feldmann
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Lisa S Hunold
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Kira C Steinkraus
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
| | - Nadir Nasir
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
| | - Christoph W Michalski
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
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10
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Rolland S, Kassis-Chikhani N, Auclin E, Bensaid S, Bidaud AL, Gerlinger MP, Blez D, Mainardi JL, Lebeaux D, Dubert M. TIVAP-related infection due to Gram-negative aerobic bacilli: should TIVAP stay or should it go? Eur J Clin Microbiol Infect Dis 2023; 42:161-168. [PMID: 36472717 DOI: 10.1007/s10096-022-04537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
We aimed to describe the outcome of totally implantable venous-access port (TIVAP)-related infections due to Gram-negative aerobic bacilli (Pseudomonas aeruginosa and other Pseudomonas spp., Acinetobacter spp., and Stenotrophomonas maltophilia), or GNAB, and assess the safety of conservative treatment. We conducted a retrospective study in a French teaching hospital, from January 2016 to December 2020, including adult patients treated for TIVAP-related infection due to GNAB. Success of conservative treatment was defined as a functional TIVAP 3 months after infection with no recurrence. We performed a bivariate analysis and analyzed causes for treatment failure. We included 68 patients (53 TIVAP-related bloodstream infections, 11 TIVAP-related infections, and 4 probable TIVAP-related infections) due to GNAB, mostly P. aeruginosa (50/68, 74%). TIVAP removal was initially decided for 49/68 patients (72%). Among the 19/68 (28%) patients with conservative treatment (all for infections caused by P. aeruginosa), 5/19 (26%) had successful treatment, 7/19 (37%) experienced failure (without sepsis or septic shock), 6/19 (32%) died within 3 months without TIVAP removal and no signs of infection recurrence, and 1 patient had TIVAP removal as it was no longer required. TIVAP-related infections caused by GNAB frequently require TIVAP removal. Conservative treatment can be performed in selected patients with a non-complicated infection caused by P. aeruginosa, who can benefit from the continuation of antineoplastic chemotherapy or palliative care. Treatment failures were not associated with sepsis or septic shock.
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Affiliation(s)
- Simon Rolland
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.,Service Des Maladies Infectieuses Et Tropicales, Hôpital de La Cavale Blanche, CHU de Brest, 29200, Brest, France
| | - Najiby Kassis-Chikhani
- Unité de Prévention du Risque Infectieux, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Edouard Auclin
- Service d'oncologie Thoracique, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Samuel Bensaid
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Anne-Laure Bidaud
- Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Marie-Paule Gerlinger
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Damien Blez
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Jean-Luc Mainardi
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.,Université Paris Cité, 75006, Paris, France
| | - David Lebeaux
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France. .,Université Paris Cité, 75006, Paris, France.
| | - Marie Dubert
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France. .,Université Paris Cité, 75006, Paris, France.
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11
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Erdemir A, Rasa HK. Impact of central venous port implantation method and access choice on outcomes. World J Clin Cases 2023; 11:116-126. [PMID: 36687176 PMCID: PMC9846971 DOI: 10.12998/wjcc.v11.i1.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing, there is still no "gold standard" for the implantation technique. AIM To identify the implantation technique that should be favored. METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated. Patients were assigned into two groups according to the access method. The first group comprised patients whose jugular veins were used, and the second group comprised patients whose subclavian veins were used. Groups were evaluated regarding age, sex, application side, primary diagnosis, active follow-up period in the hospital, chemotherapy agents administered, number of complications, and the Clavien-Dindo severity score. The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test. The χ 2 test was used to analyze the variables. RESULTS There was no statistically significant difference between the groups regarding age, sex, side, number of chemotherapy drugs, and duration of port usage (P > 0.05). Only 2 patients in group 1 had complications, whereas in group 2 we observed 19 patients with complications (P < 0.05). No port occlusion was found in group 1, but the catheters of 4 patients were occluded in group 2. One port was infected in group 1 compared to three infected ports in group 2. Two port ruptures, two pneumothorax, one revision due to a mechanical problem, one tachyarrhythmia during implantation, and four suture line problems were also recorded in group 2 patients. We also showed that it would be sufficient to evaluate and wash ports once every 2 mo. CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.
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Affiliation(s)
- Ayhan Erdemir
- Department of General Surgery, Anadolu Medical Center, Kocaeli 41400, Turkey
| | - Huseyin Kemal Rasa
- Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
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12
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Pseudomonas aeruginosa Production of Hydrogen Cyanide Leads to Airborne Control of Staphylococcus aureus Growth in Biofilm and In Vivo Lung Environments. mBio 2022; 13:e0215422. [PMID: 36129311 DOI: 10.1128/mbio.02154-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diverse bacterial volatile compounds alter bacterial stress responses and physiology, but their contribution to population dynamics in polymicrobial communities is not well known. In this study, we showed that airborne volatile hydrogen cyanide (HCN) produced by a wide range of Pseudomonas aeruginosa clinical strains leads to at-a-distance in vitro inhibition of the growth of a wide array of Staphylococcus aureus strains. We determined that low-oxygen environments not only enhance P. aeruginosa HCN production but also increase S. aureus sensitivity to HCN, which impacts P. aeruginosa-S. aureus competition in microaerobic in vitro mixed biofilms as well as in an in vitro cystic fibrosis lung sputum medium. Consistently, we demonstrated that production of HCN by P. aeruginosa controls S. aureus growth in a mouse model of airways coinfected by P. aeruginosa and S. aureus. Our study therefore demonstrates that P. aeruginosa HCN contributes to local and distant airborne competition against S. aureus and potentially other HCN-sensitive bacteria in contexts relevant to cystic fibrosis and other polymicrobial infectious diseases. IMPORTANCE Airborne volatile compounds produced by bacteria are often only considered attractive or repulsive scents, but they also directly contribute to bacterial physiology. Here, we showed that volatile hydrogen cyanide (HCN) released by a wide range of Pseudomonas aeruginosa strains controls Staphylococcus aureus growth in low-oxygen in vitro biofilms or aggregates and in vivo lung environments. These results are of pathophysiological relevance, since lungs of cystic fibrosis patients are known to present microaerobic areas and to be commonly associated with the presence of S. aureus and P. aeruginosa in polymicrobial communities. Our study therefore provides insights into how a bacterial volatile compound can contribute to the exclusion of S. aureus and other HCN-sensitive competitors from P. aeruginosa ecological niches. It opens new perspectives for the management or monitoring of P. aeruginosa infections in lower-lung airway infections and other polymicrobial disease contexts.
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13
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Witting S, Ingwersen M, Lehmann T, Aschenbach R, Eckardt N, Zanow J, Fahrner R, Lotze S, Friedel R, Lenz M, Schmidt C, Miguel D, Ludriksone L, Teichgräber U. Wound Closure After Port Implantation-a Randomized Controlled Trial Comparing Tissue Adhesive and Intracutaneous Suturing. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:749-755. [PMID: 34615593 DOI: 10.3238/arztebl.m2021.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/13/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Wound healing after pectoral port implantation is a major factor determining the success or failure of the procedure. Infection and wound dehiscence can endanger the functionality of the port system and impede chemotherapy. The cosmetic result is important for patient satisfaction as well. METHODS From August 2015 to July 2017, adult patients with an indication for port implantation were entered into a prospective, randomized and controlled single-center study. The skin incision was closed either with tissue adhesive or with an intracutaneous suture. The primary endpoints were the total score of the scar evaluated by the patient and the investigator on the POSAS scale (Patient and Observer Scar Assessment Scale: 6 [normal skin] to 60 points), blinded assessment of photographic documentation by ten evaluating physicians, and the patient's reported quality of life. The calculation of case numbers was based only on the patients' overall POSAS assessment, which was tested for non-inferiority. The secondary endpoints were other complications (infection, dehiscence) and the duration of wound closure (trial registration number NCT02551510). RESULTS 156 patients (60 ± 13 years, 64% women) participated in the study. The patientassessed total POSAS score of tissue adhesive revealed non-inferiority to suturing (adhesive 11.7 ± 5.8 vs. suture 10.1 ± 4.0, p for non-inferiority <0.001). Both the investigators in their POSAS assessments and the blinded physician evaluators in their assessment of photographically documented wounds rated wound closure by suturing better than closure with tissue adhesive. No significant differences were found between groups with respect to quality of life or the frequency of wound infection or dehiscence. CONCLUSION Closure of the upper cutaneous layer with tissue adhesive is a suitable and safe method of wound closure after port implantation.
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14
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Chang TC, Yen MH, Kiu KT. Incidence and risk factor for infection of totally implantable venous access port. Langenbecks Arch Surg 2021; 407:343-351. [PMID: 34550464 DOI: 10.1007/s00423-021-02328-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAP) have been widely used in cancer patients for many years. The early infection (within 30 days after TIVAP implantation) rate of TIVAP accounts for about one-third of all TIVAP infections, and early infection often causes port removal and affects subsequent cancer treatment. This study investigated the incidence and risk factors for early and late infection after TIVAP implantation. METHODS From January 2013 to December 2018, all adult cancer patients who received TIVAP implantation in Taipei Medical University Shuang-Ho Hospital were reviewed. We evaluated the incidence of TIVAP-related infection, patient characteristics, and bacteriologic data. Univariable analysis and multiple logistic regression analysis were used to evaluate the risk factors of TIVAP-related infection. RESULTS A total of 3001 TIVAPs were implanted in 2897 patients, and the median follow-up time was 424 days (range: 1-2492 days), achieving a combined total of 1,648,731 catheter days. Thirty-one patients (1.0%) had early infection and 167 (5.6%) patients had late infection. In multivariate analysis, TIVAP combined with other surgeries (p = 0.03) and inpatient setting (p < 0.001) was the risk factor of early infection, and TIVAP combined with other surgeries (p = 0.007), hematological cancer (p = 0.03), and inpatient setting (p < 0.001) was the risk factor of late infection. CONCLUSION Inpatient TIVAP implantation and TIVAP implantation combined with other surgeries are associated with high rates of TIVAP-related early and late infections.
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Affiliation(s)
- Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, Taipei City, 235, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Min-Hsuan Yen
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, Taipei City, 235, Taiwan
| | - Kee-Thai Kiu
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, Taipei City, 235, Taiwan
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15
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Antibiotic lock therapy for the conservative treatment of long-term intravenous catheter-related infections in adults and children: When and how to proceed? Guidelines for clinical practice 2020. Infect Dis Now 2021; 51:236-246. [PMID: 33863677 DOI: 10.1016/j.idnow.2021.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
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16
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Akhtar N, Lee L. Utilization and Complications of Central Venous Access Devices in Oncology Patients. Curr Oncol 2021; 28:367-377. [PMID: 33435136 PMCID: PMC7903275 DOI: 10.3390/curroncol28010039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.
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Affiliation(s)
- Narmeen Akhtar
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada;
- Department of Oncology, Niagara Health, St. Catharines, ON L2S 0A9, Canada
| | - Linda Lee
- Department of Oncology, Niagara Health, St. Catharines, ON L2S 0A9, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
- Correspondence: ; Tel.: +1-905-682-6451; Fax: +1-905-685-3391
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17
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Kaya E, Tollapi L, Pastore A, Aringhieri G, Maisetta G, Barnini S, Paolicchi A, Batoni G, Esin S. Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections. J Med Microbiol 2020; 69:1273-1284. [PMID: 33064069 DOI: 10.1099/jmm.0.001263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction. Totally implanted venous access ports (TIVAPs) are widely used in patients receiving long-term chemotherapy but may lead to serious complications such as catheter-related bloodstream infections (CRBSIs). Diagnosis of CRBSI requires catheter culture, but there is no consensus on microbiological culture methods to be adopted.Aim. To compare three different procedures to recover bacterial cells from colonized catheters and to determine which section of the TIVAP (i.e. tip, septum, reservoir) is the probable source of infection. To investigate the correlation between blood culture results and TIVAP culture in order to get further evidence about the utility of differential time to positivity (DTP) as a diagnostic tool before TIVAP removal.Hypothesis/Gap statement. Comparisons of different diagnostic procedures for catheter culture have been rarely reported for TIVAPs. We hypothesized that the optimization of methods to recover micro-organisms from different parts of TIVAPs may help to decrease the number of false-negative results in the diagnosis of TIVAP-related bloodstream infections.Methodology. A total of 53 TIVAPs removed because of suspected infection (n=36) or end of use (n=17) were evaluated. The reservoir, the septum and the catheter tip were separated and subjected to different treatments for the recovery of adherent micro-organisms: (a) flushing of the catheter lumen, (b) sonication and flushing, (c) treatment with dithiothreitol and flushing. The three methods were also evaluated in an in vitro catheter infection model with Staphylococcus epidermidis. Culture results were compared to those obtained from paired blood cultures drawn from TIVAP and peripheral vein and to the relative DTP.Results. The results obtained demonstrated that vigorous flushing/vortexing of the catheter lumen/septum, allows the recovery of a number of micro-organisms comparable to that of more complex procedures such as sonication or chemical treatment. Among 24 positive TIVAP-cultures, nine were tip-culture negative, whereas the corresponding reservoirs and septa were culture positive. A good correlation was observed between DTP and TIVAP cultures (P<0.001).Conclusions. The results support the evidence that sending the port reservoir in addition to the catheter tip to the microbiology laboratory may increase the sensitivity and the accuracy of CRBSI diagnosis. Moreover, when a TIVAP-related infection is suspected, DTP is a useful diagnostic tool to decide between device removal or a more conservative approach.
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Affiliation(s)
- Esingül Kaya
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Lara Tollapi
- Anesthesiology and Pain Therapy Unit, Pisa University Hospital, Pisa, Italy
| | - Alberto Pastore
- Anesthesiology and Pain Therapy Unit, Pisa University Hospital, Pisa, Italy
| | - Giacomo Aringhieri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giuseppantonio Maisetta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Adriana Paolicchi
- Anesthesiology and Pain Therapy Unit, Pisa University Hospital, Pisa, Italy
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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18
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Krümpelmann U, Boseila A, Löhnert M, Kaup O, Clarenbach JJ, Görner M. An analysis of totally implantable central venous port system infections in an urban tertiary referral center. J Chemother 2020; 33:228-237. [PMID: 33030416 DOI: 10.1080/1120009x.2020.1829327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A frequent complication of central venous port systems (CVP) is infection (CVP-I), either local (CVP-LI) or a life-threatening blood stream infection (CVP-BSI). We examined the course of CVP-I including results of an antibiotic eradication attempt of CVP-BSI. We investigated adults with CVP-I from 2010 to 2018 who had to undergo port explantation or were treated by a combination of systemic antibiotics and antibiotic lock therapy (ALT). In nine years we diagnosed 206 CVP-I (CVP-LI: 52; CVP-BSI: 152). In 146 patients with CVP-I the port system was primary explanted, while 56 patients received antibiotics/ALT. 79% of Gram negative pathogens and 50% of coagulase negative staphylococci (CoNS) were eradicated. Failure of antibiotic treatment was more often associated with short time span since CVP implantation, neutropenia and polymicrobial infection. All patients with non-neoplastic disease survived, while 18/173 patients (10%) with underlying malignant disease had a fatal outcome in the same hospital stay.
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Affiliation(s)
| | - Ahmed Boseila
- Department of Thoracic Surgery, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Mathias Löhnert
- Department of Visceral Surgery, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Olaf Kaup
- Microbiologic Laboratory, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Jacob J Clarenbach
- Zentrum für Diabetes, Nieren- und Hochdruckkrankheiten MVZ GmbH, Bielefeld, Germany
| | - Martin Görner
- Department of Oncology, Klinikum Bielefeld Mitte, Bielefeld, Germany
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19
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Taxbro K, Mernelius S, Hammarskjöld F, Hanberger H, Berg S. CE Article: Transfer Rate of Pathogens Through In Vitro Contaminated Venous Port Membranes Varies With Species, Concentration, and Injection Technique. ACTA ACUST UNITED AC 2020. [DOI: 10.2309/j.java.2019.003.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Highlights
Local SVP infection is a common and potentially avoidable complication. Local SVP infection is usually verified by cultures. The transfer rate of pathogens across the SVP membrane may be reduced by applying a positive-pressure flow technique when puncturing the membrane.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sara Mernelius
- Microbiology Laboratory, Division of Medical Diagnosis, Jönköping County, Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Sweden
| | - Håkan Hanberger
- Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Sören Berg
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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20
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Casal-Beloy I, García-Novoa A. Implantable venous devices: main complications and associated risk factors. Cir Esp 2020; 98:567-568. [PMID: 32334812 DOI: 10.1016/j.ciresp.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Isabel Casal-Beloy
- Servicio de Cirugía Pediátrica, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - Alejandra García-Novoa
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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21
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Gowin E, Świątek-Kościelna B, Mańkowski P, Januszkiewicz-Lewandowska D. The Profile of Microorganisms Responsible for Port-Related Bacteremia in Pediatric Hemato-Oncological Patients. Cancer Control 2020; 27:1073274820904696. [PMID: 32157910 PMCID: PMC7092702 DOI: 10.1177/1073274820904696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with pediatric cancer face an increased risk of infections. In most cases, these infections are associated with the use of a long-term central venous catheter. This study describes the epidemiology of a port-associated bacteremia as well as a profile of microorganisms responsible for port-associated bloodstream infections (PABSIs) in pediatric patients with cancer treated in a single center. The retrospective analysis included patients with cancer who had implanted a port, hospitalized between 2010 and 2015 at the Department of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences. The medical records of patients were reviewed for demographic characteristics, diagnosis, port-related complications, and their management. Data were collected from patients' electronic medical records containing complete information on medical examinations and supplementary tests, diagnosis, timing, and type of port-associated complications. In a study period, 277 ports were inserted to 241 patients. A total of 183 094 catheter days were analyzed. Sixteen patients had more than 1 insertion of a port. The commonest observed complication was PABSI (40.07%) and the incidence density was 0.6 per 1000 port-days. Staphylococcus was the most commonly isolated organisms from patients with PABSI. From all port-associated complications, bloodstream infections and mechanical complications were the most often observed complications. The commonest pathogens responsible for PABSI were coagulase-negative staphylococci. Pathogens resistant to standard antibiotic treatment play an important role in PABSI, with methicillin-resistant Staphylococcus epidermidis being the predominant pathogen. Port-associated bloodstream infections are a common reason for preterm removal of a port.
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Affiliation(s)
- Ewelina Gowin
- Department of Health Promotion, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Przemysław Mańkowski
- Department of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
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22
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Tsuruta S, Goto Y, Miyake H, Nagai H, Yoshioka Y, Yuasa N, Takamizawa J. Late complications associated with totally implantable venous access port implantation via the internal jugular vein. Support Care Cancer 2019; 28:2761-2768. [PMID: 31724073 DOI: 10.1007/s00520-019-05122-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/06/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Several studies have analyzed late complications associated with totally implantable venous access ports (TIVAP) implantation via the internal jugular vein (IJV); however, the reported results are inconclusive. The aim of the study is to elucidate the characteristics and risk factors of late complications associated with TIVAP implantation via the IJV. METHODS The study included 482 patients who underwent TIVAP implantation for long-term chemotherapy and/or nutritional support between April 2012 and December 2017. Most patients (95.2%) had malignant diseases. Events requiring TIVAP removal were defined as TIVAP-related complications. RESULTS The median TIVAP and global follow-ups were 319 days (IQR 152-661) and 218,971 catheter days, respectively. The 3-year cumulative TIVAP availability rate was 70%. There were 44 complications (incidence of 9.1%; 0.201 complications/1000 catheter days). Infectious, catheter-related, and port-related complications occurred in 21, 14, and 9 patients, respectively with infectious complications occurring earlier and more frequently than catheter- and port-related complications. Multivariate analysis revealed that age < 65 years and presence of non-gastrointestinal diseases were significant unfavorable factors for TIVAP-related complications. Patients with 1 and 2 of these factors had an elevated risk (2.2 and 5.4 times, respectively) compared with those without. CONCLUSIONS Among the late complications associated with TIVAP implantation via the IJV, infectious complications occur earlier and more frequently than catheter- and port-related complications. Patients with an age < 65 years and having non-gastrointestinal diseases have a significantly high risk of TIVAP-related complications.
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Affiliation(s)
- Shigeaki Tsuruta
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yasutomo Goto
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Junichi Takamizawa
- Department of Laboratory Medicine, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
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Taxbro K, Hammarskjöld F, Thelin B, Lewin F, Hagman H, Hanberger H, Berg S. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth 2019; 122:734-741. [PMID: 31005243 DOI: 10.1016/j.bja.2019.01.038] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Centrally inserted totally implanted vascular access ports (PORTs) and peripherally inserted central catheters (PICCs) are widely used for the administration of chemotherapy. Our aim was to study the incidence of catheter-related deep venous thrombosis in patients with cancer receiving chemotherapy through either a PICC or a PORT. METHODS Adults with non-haematological cancer (mainly breast and colorectal) from two Swedish oncology centres were included and followed for up to 1 yr. Patients were randomly assigned to receive a single-lumen PICC or PORT. The primary end point was the occurrence of a clinically significant catheter-related deep venous thrombosis, and the secondary end point was a composite of adverse events related to the catheter: insertion complication, thrombosis, occlusion, infection, and mechanical problems. RESULTS The trial recruited 399 participants (PICC, n=201; PORT, n=198) between March 2013 and February 2017. The PICCs were associated with 16 (8%) deep venous thromboses compared with two (1%) in the PORT group (HR=10.2; 95% confidence interval, 2.3-44.6; P=0.002). The overall incidence of composite adverse events was higher for patients with a PICC compared with those with a PORT (HR=2.7; 95% confidence interval, 1.6-4.6; P<0.001). CONCLUSIONS PICCs are associated with higher risk for catheter-related deep venous thrombosis and other adverse events when compared with PORTs. This increased risk should be considered when choosing a vascular access device for chemotherapy, especially in patients with solid malignancy. CLINICAL TRIAL REGISTRATION NCT01971021.
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Affiliation(s)
- Knut Taxbro
- University of Linköping, Linköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
| | - Fredrik Hammarskjöld
- University of Linköping, Linköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Bo Thelin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Helga Hagman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Håkan Hanberger
- University of Linköping, Linköping, Sweden; Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Sören Berg
- University of Linköping, Linköping, Sweden; Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Linköping University Hospital, Linköping, Sweden
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Uzunkaya F, Soylu Aİ, Belet Ü, Terzi Ö, Akan H. Santral venöz portların çıkarılma nedenleri: Ardışık 154 hastadan edinilen deneyim. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.417318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Medina F, Meyssonnier V, Zeller V, Heym B, Ziza JM, Marmor S. Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series. J Bone Jt Infect 2018; 3:241-244. [PMID: 30533344 PMCID: PMC6284100 DOI: 10.7150/jbji.25887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction: Prosthetic joint infections (PJIs) can be acquired hematogenously from a distant site or device. Notably, 30%-40% of patients with PJIs have Staphylococcus aureus bacteremia. No case reports or series of PJIs acquired from totally implantable venous-access device (TIVAD) infection or colonization have been published. This study was undertaken to describe epidemiological, clinical, microbiological and radiological characteristics of such PJIs, their treatments and outcomes. Methods: This retrospective study included all patients, identified in a prospective French Bone-and-Joint Infections Referral Center cohort treated between 2004 and 2017, with PJI secondary to TIVAD infection, with the same microbiologically documented microorganism isolated from both. Results: We describe six consecutive hematogenous PJIs (4 women, 2 men; median age: 66.5 years) acquired from TIVAD primary infections. The main infection risk factors were malignancy (n=5) and prior septic arthritis (n=2). Four participants' TIVADs were implanted for chemotherapy, preceding the prosthesis for one patient. The median TIVAD-implantation-to-symptom-onset interval was 12 months. Microorganisms were Staphylococcus epidermidis (n=4), Staphylococcus capitis (n=1) and Staphylococcus aureus (n=1). All TIVADs were removed. Five participants received curative treatment, with a median of 12 weeks of antibiotics. After median follow-up of 42 months, none have relapsed. Conclusions: When PJI occurs in a patient with a TIVAD, the latter must be tested as a potential source of the prosthesis infection. Conversely, PJIs must sought in all patients with bacteremia.
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Affiliation(s)
- Fernanda Medina
- Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
| | - Vanina Meyssonnier
- Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
- Internal Medicine Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
| | - Valérie Zeller
- Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
- Internal Medicine Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
| | - Beate Heym
- Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
- Microbiology Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
| | - Jean-Marc Ziza
- Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
- Internal Medicine Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
| | - Simon Marmor
- Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
- Orthopedic Surgery Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
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Yu XY, Xu JL, Li D, Jiang ZF. Late complications of totally implantable venous access ports in patients with cancer: Risk factors and related nursing strategies. Medicine (Baltimore) 2018; 97:e12427. [PMID: 30235721 PMCID: PMC6160048 DOI: 10.1097/md.0000000000012427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to assess the incidence rate and the risk factors for late complications associated with use of central totally implanted venous access devices (TIVAPs) in patients with cancer, and to devise nursing strategies to minimize late complications.This retrospective study included 500 patients with TIVAPs from 2012 to 2015. Multivariable logistic regression analysis was performed to assess the effect of sex, age, primary diagnosis, duration of surgery, and the length of hospital stay on the incidence of late complications of TIVAP.The cumulative maintenance period of TIVAP was 159,605 days. Late complications included catheter-related obstruction (n = 14; 2.8%), infection (n = 3; 0.6%), drug extravasation (n = 1; 0.2%), and catheter exposure (n = 1; 0.2%). Multivariate analyses revealed that age, breast cancer, lung cancer, and gastric cancer were risk factors for the late complications associated with TIVAP.There was a low incidence of late complications with TIVAP use. Catheter-related obstruction is the most frequent late complication of TIVAP. Risk factors for TIVAP-associated late complications include age and certain cancers, such as breast cancer, lung cancer, and gastric cancer.
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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria. Antimicrob Agents Chemother 2018; 62:AAC.00569-18. [PMID: 29987150 DOI: 10.1128/aac.00569-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022] Open
Abstract
The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.
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Yanık F, Karamustafaoğlu YA, Karataş A, Yörük Y. Experience in totally implantable venous port catheter: Analysis of 3,000 patients in 12 years. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:422-428. [PMID: 32082773 PMCID: PMC7018272 DOI: 10.5606/tgkdc.dergisi.2018.15299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to present our experience with patients who were performed totally implantable venous port catheter. METHODS Demographics-clinical features, surgical results and complications of 3,000 patients (1,824 males, 1,176 females; mean age 61.04±11.5 years; range, 18 to 88 years) who were performed totally implantable venous port catheter between March 2005 and March 2017 were evaluated retrospectively. Totally implantable venous port catheter indications, complications, catheter duration of stay, reasons for catheter removal and statistical analysis information were reported in detail by reviewing patient records. RESULTS Of the cases, the Seldinger method was used in 98%, 1% (n=36) had the catheter inserted with superficial Doppler ultrasonography, while the veins were not found in 1% (n=29) and these patients were excluded from the study. Totally implantable venous port catheter was inserted via right internal jugular vein in 2,095 patients (70%), via right subclavian vein in 470 patients (16%), via left internal jugular vein in 290 patients (10%), and via left subclavian vein in 106 patients (3%). Mean duration of stay for totally implantable venous port catheter was 46.7 months (range, 1 to 78 months). Complications were detected in a total of 288 patients (9.6%), 153 (5.1%) being early and 135 (4.5%) being late. The most common oncologic indication was colorectal cancer. The rate of port removal was 298/3,000 (9.9%) and the main reasons were infection, thrombosis, pain, and end of treatment. Totally implantable venous port catheter was required to be inserted twice in 33 patients (1%) and thrice in 14 patients (0.5%). Totally implantable venous port catheter had malposition in eight patients and all were revised successfully with over the guide method. CONCLUSION Totally implantable venous port catheter may increase the quality of life in cancer patients. Despite possible complications, totally implantable venous port catheter is safe and comfortable for long-term intravenous treatment. Possible complications may be prevented or managed when totally implantable venous port catheter is performed by surgeons with adequate experience.
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Affiliation(s)
- Fazlı Yanık
- Department of Thoracic Surgery, Medicine Faculty of Trakya University, Edirne, Turkey
| | | | - Adem Karataş
- Department of Thoracic Surgery, Medicine Faculty of Trakya University, Edirne, Turkey
| | - Yener Yörük
- Department of Thoracic Surgery, Medicine Faculty of Trakya University, Edirne, Turkey
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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: 0.9] [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: 55] [Impact Index Per Article: 7.9] [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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Comparative Analysis of Bacterial Community Composition and Structure in Clinically Symptomatic and Asymptomatic Central Venous Catheters. mSphere 2017; 2:mSphere00146-17. [PMID: 28959736 PMCID: PMC5615130 DOI: 10.1128/msphere.00146-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023] Open
Abstract
Totally implanted venous access ports (TIVAPs) are commonly used catheters for the management of acute or chronic pathologies. Although these devices improve health care, repeated use of this type of device for venous access over long periods of time is also associated with risk of colonization and infection by pathogenic bacteria, often originating from skin. However, although the skin microbiota is composed of both pathogenic and nonpathogenic bacteria, the extent and the consequences of TIVAP colonization by nonpathogenic bacteria have rarely been studied. Here, we used culture-dependent and 16S rRNA gene-based culture-independent approaches to identify differences in bacterial colonization of TIVAPs obtained from two French hospitals. To explore the relationships between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection, we analyzed the bacterial community parameters between TIVAPs suspected (symptomatic) or not (asymptomatic) of infection. Although we did not find a particular species assemblage or community marker to distinguish infection risk on an individual sample level, we identified differences in bacterial community composition, diversity, and structure between clinically symptomatic and asymptomatic TIVAPs that could be explored further. This study therefore provides a new view of bacterial communities and colonization patterns in intravascular TIVAPs and suggests that microbial ecology approaches could improve our understanding of device-associated infections and could be a prognostic tool to monitor the evolution of bacterial communities in implants and their potential susceptibility to infections. IMPORTANCE Totally implanted venous access ports (TIVAPs) are commonly used implants for the management of acute or chronic pathologies. Although their use improves the patient's health care and quality of life, they are associated with a risk of infection and subsequent clinical complications, often leading to implant removal. While all TIVAPs appear to be colonized, only a fraction become infected, and the relationship between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection is unknown. We explored bacteria present on TIVAPs implanted in patients with or without signs of TIVAP infection and identified differences in phylum composition and community structure. Our data suggest that the microbial ecology of intravascular devices could be predictive of TIVAP infection status and that ultimately a microbial ecological signature could be identified as a tool to predict TIVAP infection susceptibility and improve clinical management.
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Fernández-Cruz A, Muñoz P, Sandoval C, Fariñas C, Gutiérrez-Cuadra M, Pericás Pulido JM, Miró JM, Goenaga-Sánchez MÁ, de Alarcón A, Bonache-Bernal F, Rodríguez M, Noureddine M, Bouza Santiago E. Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm?: A prospective, multicenter cohort. Medicine (Baltimore) 2017; 96:e7913. [PMID: 28930826 PMCID: PMC5617693 DOI: 10.1097/md.0000000000007913] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/23/2017] [Accepted: 08/03/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P < .01), severe sepsis (28.6% vs 11.1%, P = .013), and IE caused by gastrointestinal streptococci (42.9% vs 16.8%, P < .01). However, catheter source (7.1% vs 29.4%, P = .003), invasive procedures (26.2% vs 44.5%, P = .044), and immunosuppressants (9.5% vs 35.6%, P = .002) were less frequent.When compared with noncancer patients, patients with cancer were more often male (75.2% vs 67.7%, P = .049), with a higher comorbidity index (7 vs 4). In addition, IE was more often nosocomial (48.7% vs 29%) and originated in catheters (23.6% vs 6.2%) (all P < .01). Prosthetic endocarditis (21.7% vs 30.3%, P = .022) and surgery when indicated (24.2% vs 46.5%, P < .01) were less common. In-hospital mortality (34.8% vs 25.8%, P = .012) and 1-year mortality (47.8% vs 30.9%, P < .01) were higher in cancer patients, although 30-day mortality was not (24.8% vs 19.3%, P = .087).A significant proportion of cases of IE (5.6%) were recorded in cancer patients, mainly as a consequence of medical interventions. IE may be a harbinger of occult cancer, particularly that of gastrointestinal or urinary origin.
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Affiliation(s)
- Ana Fernández-Cruz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058)
- Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid
| | - Carmen Sandoval
- Instituto de Investigación Sanitaria Gregorio Marañón
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid
| | - Carmen Fariñas
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Manuel Gutiérrez-Cuadra
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Juan M. Pericás Pulido
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Universitat de Barcelona, Barcelona
| | - José M. Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Universitat de Barcelona, Barcelona
| | | | - Arístides de Alarcón
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla
| | | | - MªÁngeles Rodríguez
- Department of Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo
| | - Mariam Noureddine
- Department of Infectious Diseases, Hospital Costa del Sol, Marbella, Spain
| | - Emilio Bouza Santiago
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058)
- Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid
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Voog E, Campion L, du Rusquec P, Bourgeois H, Domont J, Denis F, Emmanuel E, Dupuis O, Ganem G, Lafont C, Le Du K, Pavluc E, Pointreau Y, Roche S, Juhel-Voog L, Zinger M, Solal-Celigny P. Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer. Support Care Cancer 2017; 26:81-89. [DOI: 10.1007/s00520-017-3816-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
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Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS 2017; 125:365-375. [PMID: 28407421 DOI: 10.1111/apm.12665] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/29/2016] [Indexed: 12/28/2022]
Abstract
The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.
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Affiliation(s)
- Marie Gominet
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
| | - Fabrice Compain
- Université Paris Descartes, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Beloin
- Unité de Génétique des Biofilms, Département de Microbiologie, Institut Pasteur, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
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Long-term outcomes of totally implantable venous access devices. Support Care Cancer 2017; 25:2049-2054. [DOI: 10.1007/s00520-017-3592-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/16/2017] [Indexed: 01/17/2023]
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Coskun AK. Risk factors for central venous access port-related infection. J Formos Med Assoc 2016; 115:217. [PMID: 26459108 DOI: 10.1016/j.jfma.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/08/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ali Kagan Coskun
- Department of Surgery, Gulhane School of Medicine, Ankara, Turkey.
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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: 1.4] [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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Galy A, Lepeule R, Goulenok T, Buzele R, de Lastours V, Fantin B. Presentation and impact of catheter-associated thrombosis in patients with infected long-term central venous catheters: a prospective bicentric observational study. Ann Med 2016; 48:182-9. [PMID: 27022769 DOI: 10.3109/07853890.2016.1154981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Catheter-associated thrombosis (CAT) in patients with infected long-term central venous catheter (LTCVC) has been poorly studied. METHODS We prospectively included patients with infected LTCVC and collected clinical data. Doppler ultrasound was systematically performed to screen for CAT. Outcome (death or infection relapse) was evaluated 12 weeks after infection diagnosis. RESULTS 90 patients were included and CAT was diagnosed in 27 (30%). Local signs suggesting infection were more frequent in patients with CAT than without (11/27 versus 8/63, p = 0.03). Outcome was similar in patients with and without CAT. However, median duration of antimicrobials was longer (18 versus 14 days, p = 0.02), catheter removal tended to be more frequent (24/27 versus 46/63, p = 0.08), and anticoagulant therapy more often prescribed (17/27 versus 6/63, p < 0.01) in patients with CAT than without. Patients with occlusive thrombosis were more likely to have Staphylococcus aureus infections (4/7 versus 1/17, p = 0.02) and prolonged positivity of blood-cultures (3/7 versus 1/15, p = 0.02), than patients with non-occlusive thrombosis. CONCLUSION CAT is associated with local signs suggesting infection. A more aggressive treatment in CAT cases allowed a similar outcome at 12 weeks between patients with and without CAT. Occlusive thrombosis represented a subgroup of patients at risk of delayed clearance of bacteremia.
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Affiliation(s)
- Adrien Galy
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Raphaël Lepeule
- b Antimicrobial Stewardship Team, Assistance Publique-Hôpitaux De Paris, University Hospital Henri Mondor , Créteil , France
| | - Tiphaine Goulenok
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Rodolphe Buzele
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Victoire de Lastours
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Bruno Fantin
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
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de Cássia J, de Souza N, Gullo F, Fusco-Almeida A, Mendes-Giannini M. Fungal Biofilms: Formation, Resistance and Pathogenicity. Med Mycol 2015. [DOI: 10.1201/b18707-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Høiby N, Bjarnsholt T, Moser C, Bassi G, Coenye T, Donelli G, Hall-Stoodley L, Holá V, Imbert C, Kirketerp-Møller K, Lebeaux D, Oliver A, Ullmann A, Williams C. ESCMID∗ guideline for the diagnosis and treatment of biofilm infections 2014. Clin Microbiol Infect 2015; 21 Suppl 1:S1-25. [DOI: 10.1016/j.cmi.2014.10.024] [Citation(s) in RCA: 533] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 01/22/2023]
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Lebeaux D, Leflon-Guibout V, Ghigo JM, Beloin C. In vitro activity of gentamicin, vancomycin or amikacin combined with EDTA or l-arginine as lock therapy against a wide spectrum of biofilm-forming clinical strains isolated from catheter-related infections. J Antimicrob Chemother 2015; 70:1704-12. [PMID: 25712314 DOI: 10.1093/jac/dkv044] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/03/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Treatment of catheter-related bloodstream infections (CRBSI) is hampered by the characteristic tolerance of bacterial biofilms towards antibiotics. Our objective was to study the effect of the combination of antibiotics and the alkaline amino acid l-arginine or the cation chelator EDTA on the bacterial killing of in vitro biofilms formed by an array of clinical strains responsible for CRBSI and representative of epidemiologically relevant bacterial species. METHODS Among 32 strains described in a previous clinical study, we focused on the most antibiotic-tolerant strains including CoNS (n = 4), Staphylococcus aureus (n = 4), Enterococcus faecalis (n = 2), Pseudomonas aeruginosa (n = 4) and Enterobacteriaceae (n = 4). We used an in vitro biofilm model (96-well plate assay) to study biofilm tolerance and tested various combinations of antibiotics and non-antibiotic adjuvants. Gentamicin, amikacin or vancomycin was combined with disodium EDTA or l-arginine for 24 h to reproduce the antibiotic lock therapy (ALT) approach. Killing of biofilm bacteria was measured by cfu quantification after a vigorous step of pipetting up and down in order to detach all biofilm bacteria from the surface of the wells. RESULTS Both of our adjuvant strategies significantly increased the effect of antibiotics against biofilms formed by Gram-positive and Gram-negative bacterial pathogens. The combination of gentamicin + EDTA was active against all tested strains apart from one P. aeruginosa. The combination of gentamicin + l-arginine was active against most of the tested strains with the notable exception of CoNS for which no potentiation was observed. We also demonstrated that amikacin + EDTA was active against Gram-negative bacteria and that vancomycin + EDTA was active against Gram-positive bacteria. CONCLUSIONS The addition of EDTA enhanced the activity of gentamicin, amikacin and vancomycin against biofilms formed by a wide spectrum of bacterial strains responsible for CRBSI.
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Affiliation(s)
- David Lebeaux
- Institut Pasteur, Genetics of Biofilms Unit, Department of Microbiology, 28 rue du Dr Roux, 75724 Paris cedex 15, France Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, Université Paris Descartes, 149 Rue de Sèvres, 75743 Paris cedex 15, France
| | | | - Jean-Marc Ghigo
- Institut Pasteur, Genetics of Biofilms Unit, Department of Microbiology, 28 rue du Dr Roux, 75724 Paris cedex 15, France
| | - Christophe Beloin
- Institut Pasteur, Genetics of Biofilms Unit, Department of Microbiology, 28 rue du Dr Roux, 75724 Paris cedex 15, France
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Tsai HC, Huang LM, Chang LY, Lee PI, Chen JM, Shao PL, Hsueh PR, Sheng WH, Chang YC, Lu CY. Central venous catheter-associated bloodstream infections in pediatric hematology-oncology patients and effectiveness of antimicrobial lock therapy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:639-46. [PMID: 25311403 DOI: 10.1016/j.jmii.2014.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/13/2014] [Accepted: 07/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Central line-associated bloodstream infection (CLABSI) is a serious complication in hematology-oncology patients. This study aimed to analyze the prevalence of CLABSI and the effectiveness of antimicrobial lock therapy (ALT) in pediatric patients. METHODS BSIs of all pediatric hematology-oncology patients admitted to a children's hospital between January 2009 and December 2013 were reviewed. The United States National Healthcare Safety Network and Infectious Diseases Society of America guidelines were used to define CLABSI and catheter-related BSI (CRBSI). The incidence, laboratory and microbiology characteristics, poor outcome, and effectiveness of ALT were analyzed. RESULTS There were 246 cases of CLABSI in 146 patients (mean age, 10.0 years), including 66 (26.8%) cases of CRBSI. The incidence of CLABSI was 4.49/1000 catheter-days, and the infection was responsible for 32.9% of the complications these patients developed and 9.3% of contributable mortality. Patients with acute myeloid leukemia had the highest infection density (5.36/1000 patient-days). Enterobacteriaceae (40.2%) and coagulase-negative staphylococci (CoNS; 20.7%) were the predominant pathogens. In multivariate analysis, older age, male sex, elevated C-reactive protein, acute lymphoblastic leukemia, and candidemia were associated with poor outcome. The success rate of ALT was 58.6% (17/29) for the treatment of CoNS and 78.3% (29/37) for Enterobacteriaceae infections. Patients with candidemia (n = 18) had the highest mortality (33.4%) and catheter removal rate (66.7%). Chlorhexidine as the disinfectant decreased the 1-year CLABSI rate from 13.7/1000 to 8.4/1000 catheter-days (p = 0.02). CONCLUSION CoNS and Enterobacteriaceae are the predominant pathogens in CLABSI among pediatric hematology-oncology patients. ALT is effective and showed no significant side effect. New disinfection practice and infection control measures can decrease CLABSI.
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Affiliation(s)
- Hsing-Chen Tsai
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, New Taipei City Hospital, New Taipei City, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jong-Ming Chen
- Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Lan Shao
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Huei Sheng
- Center for Infection Control, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ching Chang
- Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Shim J, Seo TS, Song MG, Cha IH, Kim JS, Choi CW, Seo JH, Oh SC. Incidence and risk factors of infectious complications related to implantable venous-access ports. Korean J Radiol 2014; 15:494-500. [PMID: 25053910 PMCID: PMC4105813 DOI: 10.3348/kjr.2014.15.4.494] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 05/07/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs). MATERIALS AND METHODS From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. RESULTS Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). CONCLUSION The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.
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Affiliation(s)
- Jisue Shim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Myung Gyu Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - In-Ho Cha
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Jun Suk Kim
- Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Chul Won Choi
- Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Jae Hong Seo
- Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sang Cheul Oh
- Department of Oncology and Hematology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
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Lebeaux D, Chauhan A, Létoffé S, Fischer F, de Reuse H, Beloin C, Ghigo JM. pH-mediated potentiation of aminoglycosides kills bacterial persisters and eradicates in vivo biofilms. J Infect Dis 2014; 210:1357-66. [PMID: 24837402 DOI: 10.1093/infdis/jiu286] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Limitations in treatment of biofilm-associated bacterial infections are often due to subpopulation of persistent bacteria (persisters) tolerant to high concentrations of antibiotics. Based on the increased aminoglycoside efficiency under alkaline conditions, we studied the combination of gentamicin and the clinically compatible basic amino acid L-arginine against planktonic and biofilm bacteria both in vitro and in vivo. METHODS Using Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli bioluminescent strains, we studied the combination of L-arginine and gentamicin against planktonic persisters through time-kill curves of late stationary-phase cultures. In vitro biofilm tolerance towards gentamicin was assessed using PVC 96 well-plates assays. Efficacy of gentamicin as antibiotic lock treatment (ALT) at 5 mg/mL at different pH was evaluated in vivo using a model of totally implantable venous access port (TIVAP) surgically implanted in rats. RESULTS We demonstrated that a combination of gentamicin and the clinically compatible basic amino acid L-arginine increases in vitro planktonic and biofilm susceptibility to gentamicin, with 99% mortality amongst clinically relevant pathogens, i.e. S. aureus, E. coli and P. aeruginosa persistent bacteria. Moreover, although gentamicin local treatment alone showed poor efficacy in a clinically relevant in vivo model of catheter-related infection, gentamicin supplemented with L-arginine led to complete, long-lasting eradication of S. aureus and E. coli biofilms, when used locally. CONCLUSION Given that intravenous administration of L-arginine to human patients is well tolerated, combined use of aminoglycoside and the non-toxic adjuvant L-arginine as catheter lock solution could constitute a new option for the eradication of pathogenic biofilms.
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Affiliation(s)
- David Lebeaux
- Department of Microbiology, Genetics of Biofilms Unit
| | | | | | - Frédéric Fischer
- Department of Microbiology, Helicobacter Pathogenesis Unit, Institut Pasteur, Paris, France
| | - Hilde de Reuse
- Department of Microbiology, Helicobacter Pathogenesis Unit, Institut Pasteur, Paris, France
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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: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Staphylococcus epidermidis is the most common cause of primary bacteremia and infections of indwelling medical devices. The ability to cause disease is linked to its natural niche on human skin and ability to attach and form biofilm on foreign bodies. This review focuses on the S. epidermidis clinical syndromes most commonly encountered by clinicians and future potential treatment modalities.
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Affiliation(s)
- Mark E Rupp
- Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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