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TIVAP-related infection due to Gram-negative aerobic bacilli: should TIVAP stay or should it go?
Simon Rolland1,2, Najiby Kassis-Chikhani3, Edouard Auclin4
1Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.
Abstract:
We aimed to describe the outcome of totally implantable venous-access port (TIVAP)-related infections due to Gram-negative aerobic bacilli (Pseudomonas aeruginosa and other Pseudomonas spp., Acinetobacter spp., and Stenotrophomonas maltophilia), or GNAB, and assess the safety of conservative treatment. We conducted a retrospective study in a French teaching hospital, from January 2016 to December 2020, including adult patients treated for TIVAP-related infection due to GNAB. Success of conservative treatment was defined as a functional TIVAP 3 months after infection with no recurrence. We performed a bivariate analysis and analyzed causes for treatment failure. We included 68 patients (53 TIVAP-related bloodstream infections, 11 TIVAP-related infections, and 4 probable TIVAP-related infections) due to GNAB, mostly P. aeruginosa (50/68, 74%). TIVAP removal was initially decided for 49/68 patients (72%). Among the 19/68 (28%) patients with conservative treatment (all for infections caused by P. aeruginosa), 5/19 (26%) had successful treatment, 7/19 (37%) experienced failure (without sepsis or septic shock), 6/19 (32%) died within 3 months without TIVAP removal and no signs of infection recurrence, and 1 patient had TIVAP removal as it was no longer required. TIVAP-related infections caused by GNAB frequently require TIVAP removal. Conservative treatment can be performed in selected patients with a non-complicated infection caused by P. aeruginosa, who can benefit from the continuation of antineoplastic chemotherapy or palliative care. Treatment failures were not associated with sepsis or septic shock.
Insights
Totally implantable venous-access port (TIVAP) infections from Gram-negative aerobic bacilli (GNAB) often necessitate device removal. Conservative treatment for Pseudomonas aeruginosa infections showed a 26% success rate in selected patients.
Area of Science:
- Infectious Diseases
- Oncology
- Medical Devices
Background:
- Gram-negative aerobic bacilli (GNAB) are a significant cause of totally implantable venous-access port (TIVAP) infections.
- Pseudomonas aeruginosa is the most common GNAB pathogen implicated in TIVAP infections.
Purpose of the Study:
- To describe the outcomes of TIVAP-related infections caused by GNAB.
- To assess the safety and efficacy of conservative treatment for these infections.
Main Methods:
- Retrospective study of adult patients with TIVAP-related GNAB infections from January 2016 to December 2020.
- Included analysis of TIVAP removal versus conservative treatment outcomes.
- Bivariate analysis of treatment failure causes.
Main Results:
- 68 patients included, predominantly infected with Pseudomonas aeruginosa (74%).
- TIVAP removal was initially planned for 72% of patients.
- Conservative treatment in 28% of patients (all P. aeruginosa) resulted in 26% success, 37% failure, and 32% mortality within 3 months.
Conclusions:
- TIVAP infections caused by GNAB frequently require device removal.
- Conservative management may be viable for selected non-complicated P. aeruginosa infections, especially when TIVAP continuation is crucial for chemotherapy or palliative care.
- Treatment failures were not linked to sepsis or septic shock.
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