title: Long-term central venous catheter use and risk of infection in older adults with cancer.
abstract: OBJECTIVE
  Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer.
  
  
  METHODS
  We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics.
  
  
  RESULTS
  CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections.
  
  
  CONCLUSIONS
  Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality.
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY. snyderma@mskcc.org.
authors: Allison
authors: A
authors: Lipitz-Snyderman
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Kent A
authors: KA
authors: Sepkowitz
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Elena B
authors: EB
authors: Elkin
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Laura C
authors: LC
authors: Pinheiro
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Camelia S
authors: CS
authors: Sima
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Crystal H
authors: CH
authors: Son
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Coral L
authors: CL
authors: Atoria
authors: All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Peter B
authors: PB
authors: Bach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D062905:Central Venous Catheters / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology