[Totally implanted access port-related infections: features and management]

Area of Science:

• Infectious Diseases
• Medical Devices
• Clinical Microbiology

Context:

• Totally implanted access ports are crucial for long-term therapies but are associated with significant morbidity and mortality due to infections.
• Key risk factors for these infections include total parenteral nutrition, young age, insertion difficulties, poor general health, and neutropenia.
• Current guidelines emphasize a rigorous diagnostic approach for intravascular catheter-related infections.

Purpose:

• To outline the diagnostic work-up for totally implanted access port-related infections, including clinical and microbiological assessments.
• To detail the indications for catheter removal versus retention based on complication types and causative pathogens.
• To highlight the need for further research into factors influencing salvage therapy outcomes.

Summary:

• Infections associated with totally implanted access ports necessitate a comprehensive evaluation, including blood cultures from multiple sites and imaging when indicated.
• Catheter removal is mandatory for severe complications like local abscesses, septic thrombosis, endocarditis, or infections by specific pathogens (e.g., Staphylococcus aureus).
• Catheter retention with antibiotic lock therapy and systemic antibiotics may be considered in less severe cases, pending further research on failure predictors.

Impact:

• Improved diagnostic strategies can lead to timely interventions, reducing the morbidity and mortality associated with access port infections.
• Understanding risk factors and complication management optimizes patient care and resource utilization in managing device-related infections.
• Future research will refine treatment protocols, potentially improving outcomes for patients requiring long-term venous access.