title: Outcome of totally implantable venous-access port-related infections.
abstract: OBJECTIVE
  We aimed to study factors associated with the outcome of totally implantable venous-access port (TIVAP)-related infections.
  
  
  METHODS
  We conducted a prospective and observational cohort study of patients presenting with a solid tumor and TIVAP-related infection.
  
  
  RESULTS
  We monitored 97 patients for 12weeks. The case fatality at 12weeks was high (54%). Factors associated with case fatality at week 12 included patients' underlying cancer (metastatic status, parenteral nutrition, home care). Infectious complications (local abscess, hematogenous metastases, infection recurrence, septic shock) were frequently observed (48%). The delay in TIVAP removal was the only variable significantly associated with complications (TIVAP removed more than a week after removal decision, P=0.001, or more than a week after onset of clinical symptoms, P=0.002). On the basis of IDSA guidelines, we also observed that 25% of patients whose TIVAP had been removed could have benefited from a conservative treatment. Infections occurring within a month of TIVAP implantation were significantly associated with a Staphylococcus aureus infection (P=0.008).
  
  
  CONCLUSIONS
  Case fatality is high in this population of patients due to the poor status of patients. TIVAP should be promptly removed when appropriate but the patient's poor status might delay or even prevent its removal. Some patients could instead benefit from a conservative treatment. There is currently no recommendation for this therapeutic option and studies are needed to clarify its efficacy. Additionally, infection occurring within a month of TIVAP insertion could be a supplementary criterion for removal as S. aureus is associated with early infection.
authors.affiliation: Service des maladies infectieuses et tropicales, centre hospitalier et universitaire, 58, rue Montalembert, 63000 Clermont-Ferrand, France. Electronic address: mvidal@chu-clermontferrand.fr.
authors.forename: M
authors.initials: M
authors.lastname: Vidal
authors.affiliation: Service d'hygiène hospitalière, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Genillon
authors.affiliation: Service des maladies infectieuses et tropicales, médecine interne, centre hospitalier, BP 1125, 73011 Chambéry, France.
authors.forename: E
authors.initials: E
authors.lastname: Forestier
authors.affiliation: Service de médecine interne, centre hospitalier, 50, avenue de la République, BP 229, 15002 Aurillac cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Trouiller
authors.affiliation: Délégation recherche clinique & innovation, CHU de Clermont-Ferrand, villa annexe IFSI, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Service des maladies infectieuses et tropicales, centre hospitalier et universitaire, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Mrozek
authors.affiliation: Service d'hygiène hospitalière, centre hospitalier et universitaire, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Aumeran
authors.affiliation: Service des maladies infectieuses et tropicales, centre hospitalier et universitaire, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: O
authors.initials: O
authors.lastname: Lesens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D020878:Device Removal; D004866:Equipment Contamination; D005260:Female; D005602:France; D017052:Hospital Mortality; D006769:Hospitals, General / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Catheter-related infection; Cathéter central; Central venous catheter; Infection liée aux cathéters; Lock therapy; Solution verrou