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Infection Related to Implantable Central Venous Access Devices in Cancer Patients: Epidemiology and Risk Factors

Published online by Cambridge University Press:  02 January 2015

Maristela P. Freire ,
Ligia C. Pierrotti ,
Antônio E. Zerati ,
Pedro H. X. N. Araújo ,
J. M. Motta-Leal-Filho ,
Laiane P. G. Duarte ,
Karim Y. Ibrahim ,
Antonia A. L. Souza ,
Maria P. E. Diz  and
Juliana Pereira
...Show all authors
Maristela P. Freire*
Affiliation:
Infection Control Service, Institute do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Ligia C. Pierrotti
Affiliation:
Infection Control Service, Institute do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Antônio E. Zerati
Affiliation:
Vascular Surgery Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Pedro H. X. N. Araújo
Affiliation:
Thoracic Surgery Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
J. M. Motta-Leal-Filho
Affiliation:
Interventional Radiology Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Laiane P. G. Duarte
Affiliation:
Infection Control Service, Institute do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Karim Y. Ibrahim
Affiliation:
Infection Control Service, Institute do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Antonia A. L. Souza
Affiliation:
Assistance Direction, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Maria P. E. Diz
Affiliation:
Clinical Oncology Division, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Juliana Pereira
Affiliation:
Hematology Division, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Paulo M. Hoff
Affiliation:
Clinical Oncology Division, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Edson Abdala
Affiliation:
Infection Control Service, Institute do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
*
Avenida Doutor Arnaldo, 251 Cerqueira César, São Paulo, São Paulo, Brazil (maristelapf@uol.com.br)
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Abstract

Objective.

To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections.

Design.

Prospective cohort study.

Setting.

Referral hospital for cancer in São Paulo, Brazil.

Patients.

We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death.

Methods.

Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections.

Results.

During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days (P < .001). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use.

Conclusions.

Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 7 , July 2013 , pp. 671 - 677
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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