The risk factors of related infections on adult totally implantable venous access device (TIVAD): a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

WU Chaojun ¹ , MIAO Jing ¹ , ZHANG Xintong ¹ , SHEN Xiuhong ² , ZHU Jinxing ² ,  LIU Kouying ^1,2

1. School of Nursing, Nanjing Medical University, Nanjing, 210000, P.R.China;
2. The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, P.R.China;

Corresponding author：

LIU Kouying, Email: liuky188@126.com

Keywords：

Implantable port; Infection; Adult; Risk factor; Meta-analysis; Systematic review; Case-control study; Cohort study

DOI：

10.7507/1672-2531.201707075

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ObjectiveTo systematically review the risk factors of related infections on the totally implantable venous access device (TIVAD) in adult.MethodsPubMed, EMbase, CINAHL, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect case-control studies and cohort studies about the risk factors of TIVAD-related infections in adult from inception to April 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of one case-control study and 12 retrospective cohort studies involving 9 166 patients were included. The results of meta-analysis showed that: longer catheter utilization-days in the previous months (RR=1.06, 95%CI 1.02 to 1.10, P=0.001), inpatient treatment (RR=2.53, 95%CI 1.68 to 3.81, P<0.000 01), palliative care (RR=2.71, 95%CI 1.77 to 4.15,P<0.000 01), parenteral nutrition (RR=3.89, 95%CI 2.37 to 6.40,P<0.000 01), neutropenia (RR=2.20, 95%CI 1.30 to 3.72,P=0.003) and haematological malignancies (RR=3.54, 95%CI 2.03 to 6.17, P<0.000 01) were associated with increased risk of TIVAD-related infections in adult.ConclusionCurrent evidence shows that the risk factors of TIVAD-related infections include catheter utilization-days in the previous months, inpatient, palliative care, parenteral nutrition, neutropenia and hematological malignancies. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify conclusion.

Citation： WU Chaojun, MIAO Jing, ZHANG Xintong, SHEN Xiuhong, ZHU Jinxing, LIU Kouying. The risk factors of related infections on adult totally implantable venous access device (TIVAD): a systematic review. Chinese Journal of Evidence-Based Medicine, 2018, 18(2): 156-162. doi: 10.7507/1672-2531.201707075 Copy

1.	Fischer L, Knebel P, Schröder S, et al. Reasons for explantation of totally implantable access ports: a multivariate analysis of 385 consecutive patients. Ann Surg Oncol, 2008, 15(4): 1124-1129.
2.	Tacconelli E, Smith G, Hieke K, et al. Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. J Hosp Infect, 2009, 72(2): 97-103.
3.	Raad I, Hachem R, Hanna H, et al. Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis, 2007, 26(8): 549-556.
4.	Biffi R, de Braud F, Orsi F, et al. Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol, 1998, 9(7): 767-773.
5.	Hu KK, Lipsky BA, Veenstra DL, et al. Using maximal sterile barriers to prevent central venous catheter-related infection: a systematic evidence-based review. Am J Infect Control, 2004, 32(3): 142-146.
6.	Kethireddy S, Safdar N. Urokinase lock or flush solution for prevention of bloodstream infections associated with central venous catheters for chemotherapy: a meta-analysis of prospective randomized trials. J Vasc Access, 2008, 9(1): 51-57.
7.	Arora RS, Roberts R, Eden TO, et al. Interventions other than anticoagulants and systemic antibiotics for prevention of central venous catheter-related infections in children with cancer. Cochrane Database Syst Rev, 2010, (12): CD007785.
8.	Wells GA, Shea BJ, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
9.	Der Simonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials, 2007, 28(2): 105-114.
10.	陈锦, 陈秀敏. 植入式输液港相关感染危险因素分析及护理对策. 福建医药杂志, 2016, 38(2): 153-155.
11.	王黎明, 张帅, 李兴, 等. 植入式静脉输液港相关感染并发症风险因素分析. 介入放射学杂志, 2016, 25(11): 949-953.
12.	陈令红, 李薇, 谭雪红. 消化道肿瘤患者植入式静脉输液港相关性血液感染发生率和危险因素. 当代护士(中旬刊), 2017, (5): 100-102.
13.	Lee GJ, Hong SH, Roh SY, et al. A case-control study to identify risk factors for totally implantable central venous port-related bloodstream infection. Cancer Res Treat, 2014, 46(3): 250-260.
14.	Zerati AE, Figueredo TR, de Moraes RD, et al. Risk factors for infectious and noninfectious complications of totally implantable venous catheters in cancer patients. J Vasc Surg Venous Lymphat Disord, 2016, 4(2): 200-205.
15.	Wang TY, Lee KD, Chen PT, et al. Incidence and risk factors for central venous access port-related infection in Chinese cancer patients. J Formos Med Assoc, 2015, 114(11): 1055-1060.
16.	Shim J, Seo TS, Song MG, et al. Incidence and risk factors of infectious complications related to implantable venous-access ports. Korean J Radiol, 2014, 15(4): 494-500.
17.	Ji L, Yang J, Miao J, et al. Infections related to totally implantable venous-access ports: long-term experience in one center. Cell Biochem Biophys, 2015, 72(1): 235-240.
18.	Chen IC, Hsu C, Chen YC, et al. Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients. Ann Oncol, 2013, 24(2): 463-468.
19.	Touré A, Vanhems P, Lombard-Bohas C, et al. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors. Am J Infect Control, 2012, 40(10): 935-939.
20.	Chang YF, Lo AC, Tsai CH, et al. Higher complication risk of totally implantable venous access port systems in patients with advanced cancer-a single institution retrospective analysis. Palliat Med, 2013, 27(2): 185-191.
21.	Freire MP, Pierrotti LC, Zerati AE, et al. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors. Infect Control Hosp Epidemiol, 2013, 34(7): 671-677.
22.	Bamba R, Lorenz JM, Lale AJ, et al. Clinical predictors of port infections within the first 30 days of placement. J Vasc Interv Radiol, 2014, 25(3): 419-423.
23.	Bustos C, Aguinaga A, Carmona-Torre F, et al. Long-term catheterization: current approaches in the diagnosis and treatment of port-related infections. Infect Drug Resist, 2014, 7: 25-35.
24.	Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc, 2006, 81(9): 1159-1171.
25.	Raad I, Costerton W, Sabharwal U, et al. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis, 1993, 168(2): 400-407.
26.	Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med, 2004, 30(1): 62-67.
27.	Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis, 2011, 52(2): 211-212.
28.	Machado JD, Suen VM, Figueiredo JF, et al. Biofilms, infection, and parenteral nutrition therapy. J Parenter Enteral Nutr, 2009, 33(4): 397-403.
29.	Galliani S, Cremieux A, van der Auwera P, et al. Influence of strain, biomaterial, proteins, and oncostatic chemotherapy on staphylococcus epidermidis adhesion to intravascular catheters in vitro. J Lab Clin Med, 1996, 127(1): 71-80.
30.	Opilla M. Epidemiology of bloodstream infection associated with parenteral nutrition. Am J Infect Control, 2008, 36(10): S173.
31.	Nouwen JL, Wielenga JJ, van Overhagen H, et al. Hickman catheter-related infections in neutropenic patients: insertion in the operating theater versus insertion in the radiology suite. J Clin Oncol, 1999, 17(4): 1304.
32.	Elishoov H, Or R, Strauss N, et al. Nosocomial colonization, septicemia, and Hickman/Broviac catheter-related infections in bone marrow transplant recipients. A 5-year prospective study. Medicine (Baltimore), 1998, 77(2): 83-101.

1. Fischer L, Knebel P, Schröder S, et al. Reasons for explantation of totally implantable access ports: a multivariate analysis of 385 consecutive patients. Ann Surg Oncol, 2008, 15(4): 1124-1129.
2. Tacconelli E, Smith G, Hieke K, et al. Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. J Hosp Infect, 2009, 72(2): 97-103.
3. Raad I, Hachem R, Hanna H, et al. Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis, 2007, 26(8): 549-556.
4. Biffi R, de Braud F, Orsi F, et al. Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol, 1998, 9(7): 767-773.
5. Hu KK, Lipsky BA, Veenstra DL, et al. Using maximal sterile barriers to prevent central venous catheter-related infection: a systematic evidence-based review. Am J Infect Control, 2004, 32(3): 142-146.
6. Kethireddy S, Safdar N. Urokinase lock or flush solution for prevention of bloodstream infections associated with central venous catheters for chemotherapy: a meta-analysis of prospective randomized trials. J Vasc Access, 2008, 9(1): 51-57.
7. Arora RS, Roberts R, Eden TO, et al. Interventions other than anticoagulants and systemic antibiotics for prevention of central venous catheter-related infections in children with cancer. Cochrane Database Syst Rev, 2010, (12): CD007785.
8. Wells GA, Shea BJ, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
9. Der Simonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials, 2007, 28(2): 105-114.
10. 陈锦, 陈秀敏. 植入式输液港相关感染危险因素分析及护理对策. 福建医药杂志, 2016, 38(2): 153-155.
11. 王黎明, 张帅, 李兴, 等. 植入式静脉输液港相关感染并发症风险因素分析. 介入放射学杂志, 2016, 25(11): 949-953.
12. 陈令红, 李薇, 谭雪红. 消化道肿瘤患者植入式静脉输液港相关性血液感染发生率和危险因素. 当代护士(中旬刊), 2017, (5): 100-102.
13. Lee GJ, Hong SH, Roh SY, et al. A case-control study to identify risk factors for totally implantable central venous port-related bloodstream infection. Cancer Res Treat, 2014, 46(3): 250-260.
14. Zerati AE, Figueredo TR, de Moraes RD, et al. Risk factors for infectious and noninfectious complications of totally implantable venous catheters in cancer patients. J Vasc Surg Venous Lymphat Disord, 2016, 4(2): 200-205.
15. Wang TY, Lee KD, Chen PT, et al. Incidence and risk factors for central venous access port-related infection in Chinese cancer patients. J Formos Med Assoc, 2015, 114(11): 1055-1060.
16. Shim J, Seo TS, Song MG, et al. Incidence and risk factors of infectious complications related to implantable venous-access ports. Korean J Radiol, 2014, 15(4): 494-500.
17. Ji L, Yang J, Miao J, et al. Infections related to totally implantable venous-access ports: long-term experience in one center. Cell Biochem Biophys, 2015, 72(1): 235-240.
18. Chen IC, Hsu C, Chen YC, et al. Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients. Ann Oncol, 2013, 24(2): 463-468.
19. Touré A, Vanhems P, Lombard-Bohas C, et al. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors. Am J Infect Control, 2012, 40(10): 935-939.
20. Chang YF, Lo AC, Tsai CH, et al. Higher complication risk of totally implantable venous access port systems in patients with advanced cancer-a single institution retrospective analysis. Palliat Med, 2013, 27(2): 185-191.
21. Freire MP, Pierrotti LC, Zerati AE, et al. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors. Infect Control Hosp Epidemiol, 2013, 34(7): 671-677.
22. Bamba R, Lorenz JM, Lale AJ, et al. Clinical predictors of port infections within the first 30 days of placement. J Vasc Interv Radiol, 2014, 25(3): 419-423.
23. Bustos C, Aguinaga A, Carmona-Torre F, et al. Long-term catheterization: current approaches in the diagnosis and treatment of port-related infections. Infect Drug Resist, 2014, 7: 25-35.
24. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc, 2006, 81(9): 1159-1171.
25. Raad I, Costerton W, Sabharwal U, et al. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis, 1993, 168(2): 400-407.
26. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med, 2004, 30(1): 62-67.
27. Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis, 2011, 52(2): 211-212.
28. Machado JD, Suen VM, Figueiredo JF, et al. Biofilms, infection, and parenteral nutrition therapy. J Parenter Enteral Nutr, 2009, 33(4): 397-403.
29. Galliani S, Cremieux A, van der Auwera P, et al. Influence of strain, biomaterial, proteins, and oncostatic chemotherapy on staphylococcus epidermidis adhesion to intravascular catheters in vitro. J Lab Clin Med, 1996, 127(1): 71-80.
30. Opilla M. Epidemiology of bloodstream infection associated with parenteral nutrition. Am J Infect Control, 2008, 36(10): S173.
31. Nouwen JL, Wielenga JJ, van Overhagen H, et al. Hickman catheter-related infections in neutropenic patients: insertion in the operating theater versus insertion in the radiology suite. J Clin Oncol, 1999, 17(4): 1304.
32. Elishoov H, Or R, Strauss N, et al. Nosocomial colonization, septicemia, and Hickman/Broviac catheter-related infections in bone marrow transplant recipients. A 5-year prospective study. Medicine (Baltimore), 1998, 77(2): 83-101.

Chinese Journal of Evidence-Based Medicine

The risk factors of related infections on adult totally implantable venous access device (TIVAD): a systematic review

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