Risk factors and prognostic significance of infection of totally implantable vascular access port in solid tumor patients: a prospective cohort study

Amaury Bailleul (1, 2, 3) , Jean-Pierre Fulgencio (1, 2, 3) , Sophie Vimont (4, 1, 5) , Cécile Mordelet (1, 2, 3) , Benoit Ray (1, 2, 3) , Ludovic Lassel (1, 3) , Nathanaël Lapidus (6, 3, 4) , Christophe Quesnel (1, 2, 3) , Marc Garnier (1, 2, 7, 8, 3)

1 CHU Tenon [AP-HP]
2 GRC 29 - ARPE - Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire
3 SU - Sorbonne Université
4 CHU Saint-Antoine [AP-HP]
5 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
6 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
7 CHU Clermont-Ferrand
8 UCA - Université Clermont Auvergne

Objectives. Totally implantable venous access ports (TIVAP) are devices mainly used to deliver antineoplastic chemotherapies, whose insertion may be complicated by TIVAP-related infection (TIVAP-RI). This study aims to provide data on the risk factors of TIVAP-RI and its influence on patients’ prognosis. Patients and methods. Prospective observational study including adult patients with solid tumors, in whom a TIVAP was inserted to deliver antineoplastic chemotherapy between January 2018 and October 2019. Factors associated with TIVAP-RI and one-year mortality were determined using multiple logistic regressions. Results. 1014 patients were included, among whom 48 (4.7%) presented a TIVAP-RI. Gram-positive cocci and Gram-negative bacilli represented 51% and 41% of the pathogens isolated, respectively. Younger age (odds ratio [OR] 0.67; 95% Confidence Interval [0.53–0.83] per 10-year increase), WHO performance status ≥1 (OR 3.24 [1.52–7.79]), chemotherapy administration in the month before TIVAP placement (OR 2.26 [1.17–4.26]), and radiation therapy of the homolateral chest wall (OR 3.28 [1.51–6.67]) were independently associated with TIVAP-RI occurrence. During the year following TIVAP insertion, 287 (28%) patients died. TIVAP-RI was not associated with one-year mortality (OR 1.56 [0.75 - 3.19]). Conclusion. TIVAP insertion in adult patients with solid tumors is associated with a low infection rate, that did not influence one-year mortality. In addition to young age and impaired health status, TIVAP insertion in the month following the initiation of the antineoplastic chemotherapy and in an irradiated area, are two newly reported preventable TIVAP-RI risk factors.

Mots clés: infection; mortality; risk factors; solid tumor; Totally Implantable Vascular Access Port

Domaines: Sciences du Vivant [q-bio]

Amaury Bailleul, Jean-Pierre Fulgencio, Sophie Vimont, Cécile Mordelet, Benoit Ray, et al.. Risk factors and prognostic significance of infection of totally implantable vascular access port in solid tumor patients: a prospective cohort study. Infectious Diseases Now, inPress, pp.104766. ⟨10.1016/j.idnow.2023.104766⟩. ⟨hal-04178470⟩