Abstract No. 143 The patient and their port microbiome: a retrospective review of port infection leading to removal with microbiologic correlation

Abstract

The purpose of this study is to characterize the pathogens causing port-related infections and identify patient factors related to infection. Single-institution quality database (Hi-IQ) was used for retrospective identification of patients who underwent port removal for infection in calendar year 2019. Manual review of the clinical and imaging record was performed to identify outcomes and laboratory data. Stata v10.2 was used to correlate outcomes with microbiology data using multivariate regression. Of 502 patients who underwent port removal in 2019 at a tertiary academic center, 81 (16.1%) had ports removed for infection (30 male, 51 female; median age: 60 (25-83)). Thirty-two patients presented with port site infection (39.5%) and 49 patients with catheter-related bloodstream infection (60.5%). Nineteen patients had positive port cultures (59%) and 46 patients had positive blood cultures (94%). Five patients (6%) presented with polymicrobial infection. Of 70 identified pathogens, 44 (63%) were gram-positive bacteria, 15 (21%) were gram-negative bacteria, and 11 (16%) were fungal, with speciation provided in the table. Median port dwell-time was 185 days (range: 10-1990), with 48% of infected ports removed during the first 6 months. Thirty-five percent of patients were diabetic and 25% of infections were neutropenic. Patients with metastatic cancer were significantly more likely to undergo port removal due to infection (OR: 4.91 [CI 2.5-9.7], P < 0.01), while additional factors, such as cancer type (OR = 1.08 [1-1.2], P = 0.012) were not significantly related. Different species correlated with different ranges of port dwell time (see Table). Port infection microbiota are diverse, but primarily composed of skin flora and coliform species. Patient risk factors and time of port dwell may allow clinicians to better assess risk, guide preventative strategies and inform antimicrobial management of port related infection.Tabled 1Ports Removed for Infection∗X indicates that a positive culture was returned with the specified pathogen. The most common pathogens are reported.Gram-Positive Bacteria (44/70, 63%)Gram-Negative Bacteria (15/70 22%)Fungi (11/70, 16%)Port Dwell (months)n (%)Staphylococcus spp. (73% of gram+)Enterococcus spp. (20% of gram +)Escherichia coli (40% of gram -)Pseudomonas aeruginosa (33% of gram -)Candida spp. (100% of fungi)0-17 (11%)X X XX1-313 (20%)X X X X XX XXX3-611 (17%)X XX XX XX6-95 (8%)X X XX XX9-127 (11%)XXX>1222 (34%)X X X X X X∗ X indicates that a positive culture was returned with the specified pathogen. The most common pathogens are reported. Open table in a new tab