Infectious Complications of Radiologically Placed Upper Arm Ports: A Single Center Analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Apr 13

PMID 37053295

Authors

Daniel Koehler

Jan-Marcus Haus

Farzad Shenas

Holger Rohde

Harald Ittrich

Gerhard Adam

Kersten Peldschus

Affiliations

Soon will be listed here.

Abstract

Objectives: Infections are common complications in venous access ports. The presented analysis aimed to investigate the incidence, microbiological spectrum, and acquired resistances of pathogens in upper arm port associated infections to provide a decision aid in the choice of therapy.

Materials And Methods: In total, 2667 implantations and 608 explantations were performed at a high-volume tertiary medical center between 2015 and 2019. In cases with infectious complications (n = 131, 4.9%), procedural conditions and results of microbiological testing were reviewed retrospectively.

Results: Of 131 port associated infections (median dwell time 103 days, interquartile range 41-260), 49 (37.4%) were port pocket infections (PPI) and 82 (62.6%) were catheter infections (CI). Infectious complications occurred more often after implantation in inpatients compared to outpatients (P < 0.01). PPI were mainly caused by Staphylococcus aureus (S. aureus, 48.3%) and coagulase-negative staphylococci (CoNS, 31.0%). Other gram-positive and gram-negative species were encountered in 13.8% and 6.9%, respectively. CI were caused less frequently by S. aureus (8.6%) than CoNS (39.7%). Other gram-positive and gram-negative strains were isolated in 8.6% and 31.0%, respectively. Candida species were seen in 12.1% of CI. An acquired antibiotic resistance was detected in 36.0% of all significant isolates, occurring especially in CoNS (68.3%) and gram-negative species (24.0%).

Conclusions: Staphylococci comprised the largest group of pathogens in upper arm port associated infections. However, gram-negative strains and Candida species should also be considered as a cause of infection in CI. Due to the frequent detection of potential biofilm-forming pathogens, port explantation is an important therapeutic measure, especially in severely ill patients. Acquired resistances must be anticipated when choosing an empiric antibiotic treatment.

References

Shiono M, Takahashi S, Kakudo Y, Takahashi M, Shimodaira H, Kato S . Upper arm central venous port implantation: a 6-year single institutional retrospective analysis and pictorial essay of procedures for insertion. PLoS One. 2014; 9(3):e91335. PMC: 3948863. DOI: 10.1371/journal.pone.0091335. View

Busch J, Vens M, Mahler C, Herrmann J, Adam G, Ittrich H . Complication Rates Observed in Silicone and Polyurethane Catheters of Totally Implanted Central Venous Access Devices Implanted in the Upper Arm. J Vasc Interv Radiol. 2017; 28(8):1177-1183. DOI: 10.1016/j.jvir.2017.04.024. View

Teichgraber U, Kausche S, Nagel S, Gebauer B . Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol. 2011; 21(6):1224-32. DOI: 10.1007/s00330-010-2045-7. View

Jurke A, Daniels-Haardt I, Silvis W, Berends M, Glasner C, Becker K . Changing epidemiology of meticillin-resistant in 42 hospitals in the Dutch-German border region, 2012 to 2016: results of the search-and-follow-policy. Euro Surveill. 2019; 24(15). PMC: 6470371. DOI: 10.2807/1560-7917.ES.2019.24.15.1800244. View

Zaorsky N, Churilla T, Egleston B, Fisher S, Ridge J, Horwitz E . Causes of death among cancer patients. Ann Oncol. 2016; 28(2):400-407. PMC: 5834100. DOI: 10.1093/annonc/mdw604. View

Kuriakose P, Colon-Otero G, Paz-Fumagalli R . Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. J Vasc Interv Radiol. 2002; 13(2 Pt 1):179-84. DOI: 10.1016/s1051-0443(07)61936-8. View

Marcy P, Magne N, Castadot P, Bailet C, Macchiavello J, Namer M . Radiological and surgical placement of port devices: a 4-year institutional analysis of procedure performance, quality of life and cost in breast cancer patients. Breast Cancer Res Treat. 2005; 92(1):61-7. DOI: 10.1007/s10549-005-1711-y. View

Li G, Zhang Y, Ma H, Zheng J . Arm port vs chest port: a systematic review and meta-analysis. Cancer Manag Res. 2019; 11:6099-6112. PMC: 6613605. DOI: 10.2147/CMAR.S205988. View

Bodner L, Nosher J, Patel K, Siegel R, Biswal R, Gribbin C . Peripheral venous access ports: outcomes analysis in 109 patients. Cardiovasc Intervent Radiol. 2000; 23(3):187-93. DOI: 10.1007/s002700010041. View

10.

Munita J, Arias C . Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016; 4(2). PMC: 4888801. DOI: 10.1128/microbiolspec.VMBF-0016-2015. View

11.

Deppe G, Kahn M, Malviya V, Malone Jr J, CHRISTENSEN C . Experience with the P.A.S.-PORT venous access device in patients with gynecologic malignancies. Gynecol Oncol. 1996; 62(3):340-3. DOI: 10.1006/gyno.1996.0246. View

12.

Mori Y, Nagayama S, Kawamura J, Hasegawa S, Tanaka E, Okabe H . A retrospective analysis on the utility and complications of upper arm ports in 433 cases at a single institute. Int J Clin Oncol. 2015; 21(3):474-82. PMC: 4901144. DOI: 10.1007/s10147-015-0917-1. View

13.

Becker K, Both A, Weisselberg S, Heilmann C, Rohde H . Emergence of coagulase-negative staphylococci. Expert Rev Anti Infect Ther. 2020; 18(4):349-366. DOI: 10.1080/14787210.2020.1730813. View

14.

Silberzweig J, Sacks D, Khorsandi A, Bakal C . Reporting standards for central venous access. J Vasc Interv Radiol. 2003; 14(9 Pt 2):S443-52. DOI: 10.1097/01.rvi.0000094617.61428.bc. View

15.

Busch J, Herrmann J, Heller F, Derlin T, Koops A, Adam G . Follow-up of radiologically totally implanted central venous access ports of the upper arm: long-term complications in 127,750 catheter-days. AJR Am J Roentgenol. 2012; 199(2):447-52. DOI: 10.2214/AJR.11.7970. View

16.

Gustinetti G, Mikulska M . Bloodstream infections in neutropenic cancer patients: A practical update. Virulence. 2016; 7(3):280-97. PMC: 4871679. DOI: 10.1080/21505594.2016.1156821. View

17.

Kakkos A, Bresson L, Hudry D, Cousin S, Lervat C, Bogart E . Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective.... Eur J Surg Oncol. 2016; 43(4):689-695. DOI: 10.1016/j.ejso.2016.10.020. View

18.

Cassini A, Hogberg L, Plachouras D, Quattrocchi A, Hoxha A, Simonsen G . Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2018; 19(1):56-66. PMC: 6300481. DOI: 10.1016/S1473-3099(18)30605-4. View

19.

NIEDERHUBER J, Ensminger W, Gyves J, Liepman M, Doan K, Cozzi E . Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982; 92(4):706-12. View

20.

Dariushnia S, Wallace M, Siddiqi N, Towbin R, Wojak J, Kundu S . Quality improvement guidelines for central venous access. J Vasc Interv Radiol. 2010; 21(7):976-81. DOI: 10.1016/j.jvir.2010.03.006. View