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[Post-mortem evaluation following oncologic treatment of the functional and bacteriologic status of 25 permanent
Y Groebli1, J Bartolomei, P Wüthrich
1Service de Chirurgie, Hôpital des Cadolles, Neuchâtel.
Abstract:
Permanent venous access devices allow long-term parenteral treatment under relatively safe and comfortable conditions. Nevertheless, this use is associated with some degree of (particularly infectious) morbidity. 25 permanent access devices were removed surgically in immediate autopsies and cultured. Some half were infected, with a clear prevalence (40%) for Staphylococcus coagulase negative. The results were related to clinical history and compared with the figures and conclusions of other studies. It is proposed that in certain situations cultures of native blood should be carried out more frequently through the permanent venous access, with a view to possible specific targeted antibiotic therapy associated with the heparinized lock.
Insights
Half of permanent venous access devices removed during autopsy showed infection, primarily Staphylococcus coagulase-negative. This highlights the need for targeted antibiotic therapy for central venous catheter infections.
Area of Science:
- Infectious Diseases
- Medical Devices
- Microbiology
Context:
- Parenteral treatment often requires permanent venous access devices (PVADs).
- While generally safe, PVADs are associated with infectious complications.
- Autopsy studies offer insights into device-related infections.
Purpose:
- To investigate the infectious complication rate of surgically removed permanent venous access devices.
- To identify common pathogens associated with infected devices.
- To evaluate the clinical relevance of device cultures and targeted antibiotic therapy.
Summary:
- Twenty-five permanent venous access devices were surgically removed during immediate autopsies and cultured.
- Approximately 50% of the devices yielded bacterial growth, with Staphylococcus coagulase-negative identified in 40% of infected cases.
- Findings were correlated with clinical histories and compared to existing literature.
Impact:
- This study underscores the significant risk of infection associated with long-term venous access devices.
- It supports the consideration of routine blood cultures via the access device in specific clinical scenarios.
- The findings advocate for targeted antibiotic strategies, potentially including heparinized lock solutions, to manage device-related infections.