A Case-Control Study to Identify Risk Factors for Totally Implantable Central Venous Port-Related Bloodstream Infection
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
PurposeTo date, the risk factors for central venous port-related bloodstream infection (CVPBSI)in solid cancer patients have not been fully elucidated. We conducted this studyin order to determine the risk factors for CVP-BSI in patients with solid cancer. Materials and MethodsA total of 1,642 patients with solid cancer received an implantable central venous portfor delivery of chemotherapy between October 2008 and December 2011 in a singlecenter. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of130 patients, who were individually matched with respect to age, sex, and catheterinsertion time. ResultsCVP-BSI occurred most frequently between September and November (37.9%). Themost common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus(n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factorfor CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancerthan in other cancer (p=0.002). Initial metastatic disease and long catheter-stay werestatistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor formortality in patients with CVP-BSI (p=0.047). ConclusionIn analysis of the results with respect to risk factors, prolonged catheter-stay shouldbe avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastaticsolid cancer, especially non-gastrointestinal cancer. In addition, avoidance ofunnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally,considering the fact that confounding factors may have affected the results,conduct of a well-designed prospective controlled study is warranted.
Abstract
PurposeTo date, the risk factors for central venous port-related bloodstream infection (CVPBSI)in solid cancer patients have not been fully elucidated. We conducted this studyin order to determine the risk factors for CVP-BSI in patients with solid cancer. Materials and MethodsA total of 1,642 patients with solid cancer received an implantable central venous portfor delivery of chemotherapy between October 2008 and December 2011 in a singlecenter. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of130 patients, who were individually matched with respect to age, sex, and catheterinsertion time. ResultsCVP-BSI occurred most frequently between September and November (37.9%). Themost common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus(n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factorfor CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancerthan in other cancer (p=0.002). Initial metastatic disease and long catheter-stay werestatistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor formortality in patients with CVP-BSI (p=0.047). ConclusionIn analysis of the results with respect to risk factors, prolonged catheter-stay shouldbe avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastaticsolid cancer, especially non-gastrointestinal cancer. In addition, avoidance ofunnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally,considering the fact that confounding factors may have affected the results,conduct of a well-designed prospective controlled study is warranted.
참고문헌 (25)
- Gyves JW, "A totally implanted injection port system for blood sampling and chemotherapy administration", JAMA, 251, pp.2538~2541 (1984)
- Wolosker N, "Totally implantable venous catheters for chemotherapy : experience in 500 patients", Sao Paulo Med J, 122, pp.147~151 (2004)
- Ng F, "A comparison of Hickman line-and Porta-Cath-associated complications in patients with solid tumours undergoing chemotherapy", Clin Oncol(R Coll Radiol), 19, pp.551~556 (2007)
- Gallieni M, "Vascular access in oncology patients", CA Cancer J Clin, 58, pp.323~346 (2008)
- Kim JT, "Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy", Med Oncol, 29, pp.1361~1364 (2012)
- Cortelezzia A, "Central venous catheter-related complications in patients with hematological malignancies : a retrospective analysis of risk factors and prophylactic measures", Leuk Lymphoma, 44, pp.1495~1501 (2003)
- Raad I, "Sources and outcome of bloodstream infections in cancer patients : the role of central venous catheters", Eur J Clin Microbiol Infect Dis, 26, pp.549~556 (2007)
- Tacconelli E, "Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries : literature-and registry-based estimates", J Hosp Infect, 72, pp.97~103 (2009)
- Tong EN, "Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections : a retrospective cohort study", BMC Infect Dis, 9, pp.145~ (2009)
- Worth LJ, "Catheter-related bloodstream infections in hematology: time for standardized surveillance?", Cancer, 109, pp.1215~1226 (2007)
- Groeger JS, "Infectious morbidity associated with longterm use of venous access devices in patients with cancer", Ann Intern Med, 119, pp.1168~1174 (1993)
- Hsieh CC, "Analysis of risk factors for central venous port failure in cancer patients", World J Gastroenterol, 15, pp.4709~4714 (2009)
- Mollee P, "Catheter-associated bloodstream infection incidence and risk factors in adults with cancer : a prospective cohort study", J Hosp Infect, 78, pp.26~30 (2011)
- Toure A, "Totally implantable central venous access port infections in patients with digestive cancer : incidence and risk factors", Am J Infect Control, 40, pp.935~939 (2012)
- Tomlinson D, "Defining bloodstream infections related to central venous catheters in patients with cancer : a systematic review", Clin Infect Dis, 53, pp.697~710 (2011)
- Rubin DB, "Estimating causal effects from large data sets using propensity scores", Ann Intern Med, 127(8 Pt 2), pp.757~763 (1997)
- Pratt RJ, "epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England", J Hosp Infect, 65 Suppl 1, pp.S1~S64 (2007)
- Howell PB, "Risk factors for infection of adult patients with cancer who have tunnelled central venous catheters", Cancer, 75, pp.1367~1375 (1995)
- 김현정, "Safety and Effectiveness of Central Venous Catheterization in Patients with Cancer: Prospective Observational Study", Journal of Korean Medical Science, 25(12), pp.1748~1753 (2010), 대한의학회
- Bennett CL, "Colonystimulating factors for febrile neutropenia during cancer therapy", N Engl J Med, 368, pp.1131~1139 (2013)
- Dompeling EC, "Early identification of neutropenic patients at risk of grampositive bacteraemia and the impact of empirical administration of vancomycin", Eur J Cancer, 32A, pp.1332~1339 (1996)
- Pizzo PA, "Fever in immunocompromised patients", N Engl J Med, 341, pp.893~900 (1999)
- Blijlevens NM, "Empirical therapy of febrile neutropenic patients with mucositis: challenge of risk-based therapy", Clin Microbiol Infect, 7 Suppl 4, pp.47~52 (2001)
- Opelz G, "Effect of blood transfusions on subsequent kidney transplants", Transplant Proc, 5, pp.253~259 (1973)
- Innerhofer P, "Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty", Transfusion, 45, pp.103~110 (2005)