Abstract
BackgroundWhile no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis.MethodsDuring this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections.ResultsOne hundred and fifty-one patients (58 ± 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8–0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1–15.6), p = 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p = 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05–0.5), p < 0.01].ConclusionsTIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection.
Highlights
While no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis
The present study was designed to address three main objectives: (1) to determine the proportion of confirmed TIVAP-related infections in a population of patients admitted in the ICU in whom a TIVAP was removed for life-threatening sepsis, (2) to identify predictive factors of confirmed TIVAP infection in patients admitted to the ICU and (3) to assess shortand long-term outcome of patients with TIVAP-related infection and compare them with their counterparts in whom TIVAP was removed without confirmation of infection
Definition of TIVAP-related infection was adapted from the Infectious Diseases Society of America (IDSA) guidelines [6] as one of the following conditions: 1. TIVAP-related bloodstream infection, defined as (1) a positive culture of the TIVAP associated with a positive peripheral blood culture with the same microorganism or (2) a differential time to positivity of a blood culture drawn from the catheter versus from a peripheral vein [27, 28]; 2
Summary
While no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis. Implanted venous access ports (TIVAPs) are commonly used for patients requiring long-term or iterative treatments such as antineoplastic chemotherapy, In case of tunnel or port-pocket infection, TIVAPrelated bloodstream infection is obviously strongly suspected and the device should be promptly removed [6]. Lecronier et al Ann. Intensive Care (2018) 8:41 of TIVAP in case of TIVAP-related bloodstream infection, with complication like severe sepsis or/and septic shock (use of vasopressors) [6, 11], no data support this practice. Removal of TIVAP is an important decision that should be supported by clinical evidences, but predictive factors of TIVAP-related infections are lacking in ICU patients.
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