Prise en charge des infections sur cathéters à chambre implantable

Abstract

Totally implantable port is a device composed of a silicone catheter related to a reservoir inserted under the skin. These catheters have a lower rate of infection, compared with tunnelised central venous catheters, only when they are used in sequential infusions. Higher rates of infection are associated with more frequent handling of the catheter. Removal of the device associated to a systemic antibiotherapy is the standard treatment for catheter related infection, especially when the patient’s status is severe or when the infection is due to Staphylococcus aureus or Candida sp. Since few years, a treatment has been developed based on maintenance of the device using antibiotic lock technique, associated or not to a systemic antibiotherapy. Studies evaluating efficacy of this alternative in the treatment of tunnelised catheter-related infection show a rate of cure without relapse of 82%. Efficacy of this technique, however, seems less reliable in the treatment of totally implantable port-related infections, varying from 30 to 80%. The presence of fibrin clots inside the reservoir of the device limits the penetration of antibiotics explaining the persistence of micro-organisms and the higher rate of failure. Controlled studies to assess the use of urokinase associated to antibiotic lock technique might improve the efficacy of this technique and might favour the conservative treatment.