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Monday, September 17, 2018

Clinical Predictors of Port Infections in Adult Patients with Hematologic Malignancies


Summary


Infection is typically the most common long-term complication of port placement and is also the most common reason for premature removal of a port. In addition, patients with hematologic malignancies have been reported to have a higher risk of port infection relative to the solid tumor population. In this paper, the authors performed a single center retrospective review of 223 patients with hematologic malignancies who underwent port placement for chemotherapy. Prophylactic antibiotics were administered to every patient. Identification of risk factors for port infection were assessed by stratifying patients based on demographics, clinical history, medications, type of malignancy, port characteristics, and a host of laboratory values. The definition of infection was also specified according to CDC guidelines as early infection and overall infection. Early infection was defined as that occurring within 30 days of placement.

A total of 8 out of 223 (3.6%) patients had early infection. During the follow-up period 26 patients (11.7%) overall had port infections. After inclusion of variables into the final regression model, hypoalbuminemia at the time of port placement was the only independent risk factor for early port infection (p=.03). Lab values at the time of port placement were not analyzed in the context of overall infection. From a medication standpoint, steroid therapy was the only independent risk factor associated with port infection in the overall infection group (p=.002).





Table 5, 6. ALL = acute lymphocytic leukemia; AML = acute myelogenous leukemia; BMI = body mass index; CI = confidence interval; CLL = chronic lymphocytic leukemia; HR = hazard ratio; NA = nonapplicable owing to small number of patients within the subgroup; PSHREG = proportional subdistribution hazard regression.
Incorporated in multivariate logistic regression.
Significance at .05 level.


Commentary


This article is elegant in its simplicity and ability to identify potentially implementable screening practice parameters. More than any other complication, infection tends to be the most perseverated upon in regards to port placements. This is even more paramount for patients with hematologic malignancies who will likely suffer severe leukopenia after initiation of chemotherapy. The results of this study suggest that initiation of pre-procedural screening for patients with hypoalbuminemic states may prove beneficial in minimizing early port infections although further prospective randomized trials may be needed. On the contrary, steroids were frequently (though not always) a component of chemotherapy regimens in this study and are likely non-modifiable parameters to minimize port infections. Port placements in these patients are an absolute necessity and delaying placement to discontinue steroid therapy is probably not in their best interest. These decisions will likely need to be made on a case by case basis. However, a concerted effort to improve nutrition and potentially increase albumin levels is an easily modifiable and low/no risk intervention that is probably overlooked in its significance.

Click here for abstract

Shunqing Zhang, MS, Katsuhiro Kobayashi, MD, Masoud Faridnia, MD, Philip Skummer, MPH, Dianbo Zhang, MD, Mitchel I. Karmel, MD. Clinical Predictors of Port Infections in Adult Patients with Hematologic Malignancies. J Vasc Interv Radiol 2018; 29: 1148-1155.

Post Author:
Cane Hoffman, MD, PGY-5
Department of Radiology
Wake Forest Baptist Medical Center
@WakeForest_IR

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