Factors for bloodstream infection in totally implantable venous-access ports

Abstract

Introduction: Central line-associated bloodstream infection (CLABSI) associated with implanted central venous (CV)-access ports (CV ports) remains one of the most serious complications that can worsen patient outcomes. Despite the importance of this problem, comprehensive reports are limited. Here we report an analysis of CLABSI risk factors in patients with CV ports at our institution.

Methods: Data from patients who had CV ports placed between January 2018 and March 2023 were retrospectively collected and analyzed. The primary outcome was the incidence of CLABSI, which was determined based on the Japanese Healthcare Associated Infections Surveillance criteria. To identify independent risk factors for CLABSI, univariate and multivariate analyses were performed to investigate 19 factors, including sex, age, cancer carriage status, inflammatory bowel disease (IBD), and drugs administered through CV ports.

Results: Out of 867 patients with a CV port, CLABSI was observed in 117 patients (13.5 %), with an incidence of CLABSI of 0.45 per 1000 device-days (laboratory-confirmed bloodstream infection: 0.31, clinical sepsis: 0.14). Multivariate analysis identified IBD [Odds ratio (OR): 4.47, 95 % Confidence Interval (CI): 2.34-8.52] and the administration of lipid emulsions [OR: 4.28, 95 % CI: 2.01-9.13] as independent risk factors for CLABSI. Multivariate analysis for cancer patients identified the use of lipid emulsions (OR: 5.39, 95 % CI: 2.38-12.24) as an independent risk factor for CLABSI.

Conclusion: Close monitoring is essential when patients with a CV port receive lipid emulsions. Placement of a CV port may be avoided in patients with a history of IBD if possible.

Keywords: Central line-associated bloodstream infections; Central venous-access ports; Inflammatory bowel disease; Risk factor.