Skummer Philip, Kobayashi Katsuhiro, DeRaddo Joseph Sullivan, Blackburn Taylor, Schoeneck Mason, Patel Jayminkumar, Jawed Mohammed
Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Radiology, State University of New York, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.
J Vasc Interv Radiol. 2020 Sep;31(9):1427-1436. doi: 10.1016/j.jvir.2020.05.018. Epub 2020 Aug 11.
The purpose of this study was to retrospectively investigate risk factors for chest port (port) infections within 30 days of placement (early port infections) in adult oncologic patients.
This single-institution, three-center retrospective study identified 1,714 patients (868 males, 846 females; median age 60.0 years old) who underwent port placement between January 2013 and August 2017. All patients received an intravenous antibiotic prior to port placement. The median absolute neutrophil count was 5,260 cells/μL, the median white blood cell (WBC) count was 7,700 cells/μL, and the median serum albumin was 4.00 g/dL at the time of port placement. Double-lumen ports were most commonly implanted (74.85%) more frequently in an outpatient setting (72.69%). Risk factors for early port infections were elucidated using univariate and multivariate proportional subdistribution hazard regression analyses.
A total of 20 patients (1.2%) had early port infections; 15 patients (0.9%) had positive blood cultures. The mean time to infection was 20 days (range, 9-30 days). The port-related 30-day mortality rate was 0.2% (4 of 1,714 patients). Most bloodstream infections were attributed to Staphylococcus spp. (n = 11). In multivariate analysis, hematologic malignancy (hazard ratio [HR], 2.61; 95% confidence interval (CI), 1.15-5.92.; P = .02), hypoalbuminemia (albumin <3.5 g/dL; HR, 3.52; 95% CI: 1.48-8.36; P = .004), leukopenia (WBC <3,500 cells/μL; HR, 3.00; 95% CI: 1.11-8.09; P = .03), and diabetes mellitus (HR, 3.71; 95% CI: 1.57-8.83) remained statistically significant risk factors for early port infection.
Hematologic malignancy, hypoalbuminemia, leukopenia, and diabetes mellitus at the time of port placement were independent risk factors for early port infections.
本研究的目的是回顾性调查成年肿瘤患者在置入胸部端口（端口）后30天内发生端口感染（早期端口感染）的危险因素。
这项单机构、三中心的回顾性研究纳入了2013年1月至2017年8月期间接受端口置入的1714例患者（868例男性，846例女性；中位年龄60.0岁）。所有患者在端口置入前均接受静脉抗生素治疗。端口置入时，绝对中性粒细胞计数中位数为5260个细胞/μL，白细胞（WBC）计数中位数为7700个细胞/μL，血清白蛋白中位数为4.00 g/dL。双腔端口最常植入（74.85%），在门诊环境中植入频率更高（72.69%）。使用单因素和多因素比例子分布风险回归分析阐明早期端口感染的危险因素。
共有20例患者（1.2%）发生早期端口感染；15例患者（0.9%）血培养阳性。感染的平均时间为20天（范围9 - 30天）。端口相关的30天死亡率为0.2%（1714例患者中的4例）。大多数血流感染归因于葡萄球菌属（n = 11）。在多因素分析中，血液系统恶性肿瘤（风险比[HR]，2.61；95%置信区间[CI]，1.15 - 5.92；P = .02）、低白蛋白血症（白蛋白<3.5 g/dL；HR，3.52；95% CI：1.48 - 8.36；P = .004）、白细胞减少症（WBC<3500个细胞/μL；HR，3.00；95% CI：1.11 - 8.09；P = .03）和糖尿病（HR，3.71；95% CI：1.57 - 8.83）仍然是早期端口感染的统计学显著危险因素。
端口置入时的血液系统恶性肿瘤、低白蛋白血症、白细胞减少症和糖尿病是早期端口感染的独立危险因素。
