Morbidity and mortality after a totally implantable venous access port (TIVAP)-related
infection in oncology patients have rarely been studied. We conducted this study to assess the incidence and factors associated with the following outcome endpoints:
severe sepsis or
septic shock at presentation, cancellation of
antineoplastic chemotherapy, and mortality at week 12. We conducted a prospective single-center observational study including all adult patients with solid
cancer who experienced a TIVAP-related
infection between February 1, 2009, and October 31, 2010. Patients were prospectively followed for 12 weeks. Among 1728 patients receiving
antineoplastic chemotherapy during the inclusion time, 72 had an episode of TIVAP-related
infection (4.2%) and were included in the study (median age, 60 yr; range, 28-85 yr). The incidence of complications was 18% for
severe sepsis or
septic shock (13/72 patients), 30% for definitive cancellation of
antineoplastic chemotherapy (14/46 patients who still had active treatment), and 46% for death at week 12 (33/72 patients). Factors associated with
severe sepsis or
septic shock were an elevated
C-reactive protein (CRP) level and an
infection caused by Candida species; 4 of the 13 severe episodes (31%) were due to
coagulase-negative staphylococci (CoNS). Factors associated with death at week 12 were a low median Karnofsky score, an elevated Charlson comorbidity index, the metastatic evolution of
cancer,
palliative care, and an elevated CRP level at presentation. Hematogenous complications (that is,
infective endocarditis, septic
thrombophlebitis, septic pulmonary emboli,
spondylodiscitis,
septic arthritis, or organ
abscesses) were found in 8 patients (11%). In conclusion, patients' overall condition (comorbidities and autonomy) and elevated CRP level were associated with an unfavorable clinical outcome after a TIVAP-related
infection. Candida species and CoNS were responsible for
severe sepsis or
septic shock.