[Totally implanted access port-related infections: features and management].
Totally implanted access port-related infections are responsible for their own morbidity and mortality. Main risk factors of totally implanted access port-related infections are total parenteral nutrition, young age, difficulties during insertion, poor general status and neutropenia. Recent guidelines defined intravascular catheter-related infections. This relies on a strict clinical and microbiological work-up including simultaneous culture of blood drawn from the catheter and a peripheral vein. The search for local or general complications is mandatory: clinical and possibly echographic assessments are therefore needed. Depending on the context and the type of microorganism, this evaluation may include transoesophageal echocardiography and search for suppurative thrombosis in case of catheter-related bloodstream infection caused by Staphylococcus aureus. Indeed, intravascular complications in this setting are frequent. Catheter removal is mandatory in case of local complication (tunnel infection or port pocket abscess), septic thrombosis, infective endocarditis, osteomyelitis, septic shock or infection related to specific pathogens (S. aureus, Candida spp., Pseudomonas aeruginosa). Otherwise, retention of the catheter might be proposed given results from recent studies including antibiotic lock therapy associated with systemic antibiotic. Future studies must focus on defining more precisely the factors associated with salvage therapy failure including host, pathogens virulence factors and biofilm formation.
Lebeaux
D
D
Service de médecine interne, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France. david.lebeaux@yahoo.fr
Zarrouk
V
V
Leflon-Guibout
V
V
Lefort
A
A
Fantin
B
B
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection; D020878:Device Removal; D004866:Equipment Contamination; D019317:Evidence-Based Medicine; D005602:France / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D015201:Meta-Analysis as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
D000900:Anti-Bacterial Agents