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Diagnosis of venous access port-related infections
M C Douard1, G Arlet, P Longuet
1Département d'Anesthésiologie, Hôpital Saint Louis, 75475 Paris Cedex 10, France.
Abstract:
The accumulation of infected clots under the silicone septum of the reservoir of venous access ports (VAPs) has been reported. We analyzed the relationship between these deposits and the occurrence of VAP-related bloodstream infections (VAP-BSIs) by (1) evaluating the accuracy of paired quantitative blood cultures for diagnosing VAP-BSI before the removal of the device and (2) assessing the accuracy of cultures of the tip and septum (i.e., the internal lumen of the VAP) for diagnosing VAP-BSI after removal of the device. Over a 16-month period, all VAPs removed were prospectively investigated. Before VAP removal, paired quantitative blood cultures were 77% sensitive and 100% specific and had a positive predictive value of 100% and a negative predictive value of 98% for diagnosing VAP-BSI. After VAP removal, tip culture was only 46% sensitive, whereas septum culture was 93.3% sensitive for confirming the diagnosis of VAP-BSI. Thus infected deposits that accumulate under the VAP septum are the source of VAP-BSI.
Insights
Infected clots under venous access port (VAP) septums cause VAP-related bloodstream infections (VAP-BSIs). Septum cultures after VAP removal accurately diagnose these infections, unlike tip cultures.
Area of Science:
- Infectious Diseases
- Medical Devices
- Clinical Microbiology
Background:
- Venous access ports (VAPs) are susceptible to infected clot accumulation under the silicone septum.
- This accumulation is a suspected source of VAP-related bloodstream infections (VAP-BSIs).
Purpose of the Study:
- To evaluate paired quantitative blood cultures for diagnosing VAP-BSI before VAP removal.
- To assess the accuracy of VAP tip and septum cultures for diagnosing VAP-BSI after VAP removal.
Main Methods:
- Prospective investigation of all removed VAPs over 16 months.
- Analysis of paired quantitative blood cultures before VAP removal.
- Culture analysis of VAP tips and septums post-removal.
Main Results:
- Pre-removal: Paired blood cultures showed 77% sensitivity and 100% specificity for VAP-BSI.
- Post-removal: Septum cultures demonstrated 93.3% sensitivity, while tip cultures had only 46% sensitivity.
Conclusions:
- Infected deposits beneath the VAP septum are the primary source of VAP-BSIs.
- Septum cultures are highly accurate for confirming VAP-BSI diagnosis after device removal.