title: Clinical outcome after a totally implantable venous access port-related infection in cancer patients: a prospective study and review of the literature.
abstract: Morbidity and mortality after a totally implantable venous access port (TIVAP)-related infection in oncology patients have rarely been studied. We conducted this study to assess the incidence and factors associated with the following outcome endpoints: severe sepsis or septic shock at presentation, cancellation of antineoplastic chemotherapy, and mortality at week 12. We conducted a prospective single-center observational study including all adult patients with solid cancer who experienced a TIVAP-related infection between February 1, 2009, and October 31, 2010. Patients were prospectively followed for 12 weeks. Among 1728 patients receiving antineoplastic chemotherapy during the inclusion time, 72 had an episode of TIVAP-related infection (4.2%) and were included in the study (median age, 60 yr; range, 28-85 yr). The incidence of complications was 18% for severe sepsis or septic shock (13/72 patients), 30% for definitive cancellation of antineoplastic chemotherapy (14/46 patients who still had active treatment), and 46% for death at week 12 (33/72 patients). Factors associated with severe sepsis or septic shock were an elevated C-reactive protein (CRP) level and an infection caused by Candida species; 4 of the 13 severe episodes (31%) were due to coagulase-negative staphylococci (CoNS). Factors associated with death at week 12 were a low median Karnofsky score, an elevated Charlson comorbidity index, the metastatic evolution of cancer, palliative care, and an elevated CRP level at presentation. Hematogenous complications (that is, infective endocarditis, septic thrombophlebitis, septic pulmonary emboli, spondylodiscitis, septic arthritis, or organ abscesses) were found in 8 patients (11%). In conclusion, patients' overall condition (comorbidities and autonomy) and elevated CRP level were associated with an unfavorable clinical outcome after a TIVAP-related infection. Candida species and CoNS were responsible for severe sepsis or septic shock.
authors.affiliation: From the Service de Médecine Interne (DL, JGD, AF, VZ, BF), Unité d'Epidémiologie et de Recherche Clinique (BL), Service de Microbiologie (VLG, SB),Service d'Oncologie Médicale (CD), Service d'Hépatologie et Gastroentérologie (OH), and Service d'Anesthésie-Réanimation (CT), Hôpital Beaujon, AP-HP, Clichy; and Service de Microbiologie (RR), Service d'Hépatologie etGastroentérologie (ALP), Service de Pneumologie (BC, MF), Service de Médecine Interne (TP), and Service d'Oto-rhino Laryngologie (BB), Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Lebeaux
authors.forename: Béatrice
authors.initials: B
authors.lastname: Larroque
authors.forename: Justine
authors.initials: J
authors.lastname: Gellen-Dautremer
authors.forename: Véronique
authors.initials: V
authors.lastname: Leflon-Guibout
authors.forename: Chantal
authors.initials: C
authors.lastname: Dreyer
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bialek
authors.forename: Antoine
authors.initials: A
authors.lastname: Froissart
authors.forename: Olivia
authors.initials: O
authors.lastname: Hentic
authors.forename: Catherine
authors.initials: C
authors.lastname: Tessier
authors.forename: Raymond
authors.initials: R
authors.lastname: Ruimy
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Pelletier
authors.forename: Bruno
authors.initials: B
authors.lastname: Crestani
authors.forename: Michel
authors.initials: M
authors.lastname: Fournier
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
authors.forename: Béatrix
authors.initials: B
authors.lastname: Barry
authors.forename: Virginie
authors.initials: V
authors.lastname: Zarrouk
authors.forename: Bruno
authors.initials: B
authors.lastname: Fantin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012772:Shock, Septic / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome