Clinical outcome after a totally implantable venous access port-related infection in cancer patients: a prospective study and review of the literature

David Lebeaux, Béatrice Larroque, Justine Gellen-Dautremer, Véronique Leflon-Guibout, Chantal Dreyer, Suzanne Bialek, Antoine Froissart, Olivia Hentic, Catherine Tessier, Raymond Ruimy, Anne-Laure Pelletier, Bruno Crestani, Michel Fournier, Thomas Papo, Béatrix Barry, Virginie Zarrouk, Bruno Fantin, David Lebeaux, Béatrice Larroque, Justine Gellen-Dautremer, Véronique Leflon-Guibout, Chantal Dreyer, Suzanne Bialek, Antoine Froissart, Olivia Hentic, Catherine Tessier, Raymond Ruimy, Anne-Laure Pelletier, Bruno Crestani, Michel Fournier, Thomas Papo, Béatrix Barry, Virginie Zarrouk, Bruno Fantin

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.

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