title: Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients?
abstract: It was a dogma that patients with diabetes mellitus (DM) are at increased risk of infection or death associated with an infection. However, in cancer patients, this has not been well investigated. The aim was to investigate whether diabetic patients with cancer are at high risk of central venous access port (CVAP)-related bloodstream infection (BSI), and to analyse mortality after CVAP-BSI. A total of 17 patients with type 1 DM (T1DM), 66 with type 2 DM (T2DM) and 307 non-diabetic patients were included. Each patient was followed up until the first late CVAP-BSI or for a maximum for 1 year in the absence of a CVAP-BSI. Fifty-three CVAP-BSIs occurred in 66,528 catheter-days. The cumulative incidence of CVAP-BSI was not higher in T1DM (5.9 %; p = 0.17) and T2DM (19.7 %; p = 0.70) compared with the non-diabetic patients (12.7 %). However, in patients with CVAP-BSI, the 1-month crude mortality rate was higher in DM patients (42.9 % vs. 15.4 %; p = 0.04), whereas the mortality in patients without CVAP-BSI was similar in both groups of patients (19.8 % vs. 17.1 %; p = 0.58). Of the 12 deaths that occurred within 1 month of CVAP-BSI, 16.66 % was attributable to CVAP-BSI. The predictive factor of 1-month mortality was DM (p = 0.04). Parenteral nutrition (PN) was independently associated with CVAP-BSI in diabetic patients (p = 0.001). In this study, diabetes did not increase the risk of CVAP-BSI, but mortality was higher in diabetic patients who had a CVAP-BSI. This suggests, in addition to medical treatment, CVAP should be withdrawn after infection onset.
authors.affiliation: INSERM Unit 1060/INRA 1235, University of Lyon, Lyon, France. abdoulayek2002@yahoo.fr
authors.forename: A
authors.initials: A
authors.lastname: Touré
authors.forename: P
authors.initials: P
authors.lastname: Vanhems
authors.forename: C
authors.initials: C
authors.lastname: Lombard-Bohas
authors.forename: J-C
authors.initials: JC
authors.lastname: Souquet
authors.forename: M
authors.initials: M
authors.lastname: Lauverjat
authors.forename: C
authors.initials: C
authors.lastname: Chambrier
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis