An analysis of totally implantable central venous port system infections in an urban tertiary referral center

Abstract

A frequent complication of central venous port systems (CVP) is infection (CVP-I), either local (CVP-LI) or a life-threatening blood stream infection (CVP-BSI). We examined the course of CVP-I including results of an antibiotic eradication attempt of CVP-BSI. We investigated adults with CVP-I from 2010 to 2018 who had to undergo port explantation or were treated by a combination of systemic antibiotics and antibiotic lock therapy (ALT). In nine years we diagnosed 206 CVP-I (CVP-LI: 52; CVP-BSI: 152). In 146 patients with CVP-I the port system was primary explanted, while 56 patients received antibiotics/ALT. 79% of Gram negative pathogens and 50% of coagulase negative staphylococci (CoNS) were eradicated. Failure of antibiotic treatment was more often associated with short time span since CVP implantation, neutropenia and polymicrobial infection. All patients with non-neoplastic disease survived, while 18/173 patients (10%) with underlying malignant disease had a fatal outcome in the same hospital stay.

Keywords:

• Central venous port infection
• blood stream infection
• Gram negative pathogens
• coagulase negative staphylococci
• antibiotics
• antibiotic lock therapy (ALT)
• oncologic patients

Disclosure statement

The autors report no conflict of interest.

Additional information

Notes on contributors

Ulrich Krümpelmann

Ulrich Krümpelmann worked as senior consultant for hematology and oncology since 1992 in Bielefeld. In 2007, he completed the training as an infectiologist and in 2013, the training in antibiotic stewardship.

Ahmed Boseila

Ahmed Boseila was appointed as Professor of Cardiac and Thoracic Surgery in 2001. Since 2009, he has served as chairman of the Department of Thoracic Surgery at Klinikum Bielefeld Mitte.

Mathias Löhnert

Mathias Löhnert has served as chairman of the department of general surgery and coloproctology at Klinikum Bielefeld Rosenhöhe. During his tenure, he has led the department to become certified as a center of competence for coloproctology, surgical endoscopy and surgical sonography.

Olaf Kaup

Olaf Kaup received the degree doctor of science in 2009 and worked as leader of microbiological departments in Osnabrueck and Essen with focus on microbiological diagnostics and antibiotic stewardship. Since 2018, he assumed the leadership of the microbiological department at Klinikum Bielefeld.

Jacob J. Clarenbach

Jacob J Clarenbach has served as an attending physician at Montefiore Medical Center in New York from 2012 to 2017. He also held faculty appointments as instructor of medicine and assistant professer of medicine at Albert Einstein College of Medicine in New York. In 2017, he returned to Germany, where he now works as a nephrologist in private practice.

Martin Görner

Martin Görner had a three-year fellowship at the Fred Hutchinson Cancer Research Center in Seattle (Washington, USA). From 2000 to 2003, he led the hematological intensive care unit and the unit for allogenic stem cell transplantation at the University Hospital of Heidelberg. Since 2003, he has served as chairman of the Department of Hematology, Oncology and Palliative Care at Klinikum Bielefeld.