Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients.
BACKGROUND
The purpose of this study is to characterize the risk factors of bloodstream infection (BSI) associated with the use of permanent implantable venous ports (Port-A) in solid cancer patients.


METHODS
Solid cancer patients implanted with a Port-A were prospectively observed for the occurrence of Port-A-associated BSI (PABSI), defined as BSI without other identifiable infection foci. A PABSI risk score was developed using the Cox proportional hazards model.


RESULTS
A total of 415 patients were registered; 88 PABSI episodes occurred in 58 patients (incidence1.05 per 1000 catheter-days). All but one patient had stage IV cancer. Independent predictors of PABSI occurrence included neutropenia, total parenteral nutrition (TPN), chronic steroid use, invasive procedures, postoperative antibiotics, and preoperative antibiotics. A PABSI risk score with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%) was defined for stage IV cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, -0.970; postoperative antibiotics, +0.959; and invasive procedures, +1.098. The median PABSI-free survival was 4.47 months for patients with scores ≥ 0 but not reached for patients with scores <0 (P < 0.0001).


CONCLUSIONS
The PABSI risk score can assist in identifying high-risk solid cancer patients and may assist in designing future preventive strategies.
Department of Oncology, National Taiwan University Hospital, Taipei; Department of Oncology, National Taiwan University Hospital, Yunlin Branch, Huwei.
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Chen
Department of Oncology, National Taiwan University Hospital, Taipei; Department of Internal Medicine, National Taiwan University Hospital, Taipei.
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Hsu
Department of Oncology, National Taiwan University Hospital, Yunlin Branch, Huwei; Center for Infection Control, National Taiwan University Hospital, Taipei.
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YC
Chen
Center for Infection Control, National Taiwan University Hospital, Taipei; Department of Nursing, National Taiwan University Hospital, Taipei.
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Chien
Department of Oncology, National Taiwan University Hospital, Taipei; Department of Oncology, National Taiwan University Hospital, Yunlin Branch, Huwei.
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Kao
Department of Nursing, National Taiwan University Hospital, Taipei.
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Chang
Graduate Institute of Nursing, National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taiwan.
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Hu
Department of Oncology, National Taiwan University Hospital, Taipei; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: khyeh@ntu.edu.tw.
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Yeh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012306:Risk; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D013534:Survival; D062666:Vascular Access Devices / Q000382:microbiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents