Implantable Central Venous Port Infections in Patients with Head & Neck (H&N) Cancer on a Research Protocol

Background: Implantable ports are reported to have a lower risk of infection when compared to tunneled catheters. Recently, the investigators of a cetuximab-containing research protocol for H&N cancer therapy at an academic medical center noticed a high rate of bacteremia in patients with implantable ports and asked the infection control team to investigate.

Objective: To determine the proportion of patients with implantable ports that developed port infection during the study period and assess the risk of infection in H&N cancer patients on the study chemoradiation research protocol (cetux protocol) as compared to other patients with ports and to H&N cancer patients on a similar study protocol (comparison protocol) that did not include cetuximab.

Methods:   Port infection was defined as blood cultures positive for a pathogenic organism, site/hardware cultures positive for a pathogenic organism, or removal of the port for infection. All patients on the cetux protocol with implantable ports were included in the analysis.  Because the cetux protocol patients all had ports placed between Sept, 2006 and June, 2010, a sequential 1 in 6 sample of all patients with ports placed during this time frame were included for comparison.  Additionally, all patients on the comparison protocol with ports placed during the same time frame were included. Data regarding timing and reason for port removal as well as microbiology and timing of blood and port site/hardware cultures were collected starting from the day of catheter implantation.  Statistical analysis consisted of univariate chi square test for significance using Stata 11 software. 

Results: 68 patients on the cetux protocol had implantable ports.  303 other patients with implantable ports including 38 patients with implantable ports on the comparison protocol were included in the analysis.  Overall, 24% (88/371) of patients included in the study developed a port infection, 18% (67/371) had significant bacteremia, 12% (46/371) had significant positive hardware or site cultures, and 17% (64/371) had documented port removal for infection.  Follow-up time ranged from 1-45 months.  46% of H&N cancer patients on the cetuximab-containing research protocol developed infection and were more likely to develop infection than other patients with ports.  These results are detailed in table 1.

Conclusions: Although catheter days were not measured in this study, the follow-up time period for some patients was longer than previously reported.  This preliminary investigation suggests that implantable ports may have a higher than expected risk of infection when followed for the life-span of the port and that specific populations or therapeutic regimens may influence the risk of infection but more study is needed. More stringent infection control practices may be needed to prevent infection in implantable ports.

 ADDIN EN.REFLIST