Prophylactic Antibiotic Use Prior to Port Placement and Its Effect on Insertion-Related Infection Rates: A Five-Year Retrospective Review

Abstract

Purpose The aim of this study was to compare insertion-related port infection rates between patients who received intraprocedural prophylactic antibiotics versus those who did not.

Materials and Methods All patients who underwent port insertion by interventional radiology from 7/1/ 2015 through 7/1/2020 at a single U.S.-based Health System were identified using electronic medical records database. During this period, 2,099 patients underwent port placement at three hospitals within the same health system. One-thousand sixty-three patients who underwent port placement at one hospital received periprocedural antibiotics and 1,036 patients at the two other hospitals did not receive antibiotics. Retrospective data were reviewed on each patient including demographics, reason for port insertion, and evidence of port infection. All relevant data up to 30 days postinsertion were reviewed, including blood cultures, unplanned readmissions, emergency room visits, and clinic visits. Qualitative trends were evaluated for various subgroups including presence of bacteremia, time from insertion, and demographics. Patients with an obvious external source of infection were excluded.

Results Insertion-related infection rate was 0.9% for the entire cohort, 1.23% for the antibiotic group, and 0.68% for the nonantibiotic group. The insertion-related infection for adult patients was 0.88% for the antibiotic group and 0.68% for the nonantibiotic group. The pediatric insertion-related infection rate was 7.69%, all of whom received intravenous antibiotics. No other clear qualitative differences were noted for analyzed subgroups.

Conclusion This study demonstrates low insertion-related port infection rate with no clinically significant difference between the groups that did or did not receive antibiotics. Subgroup analysis showed an exceptionally high infection rate in the pediatric population despite receiving preprocedure antibiotics.

Keywords

antibiotics - implanted port - infection - vascular

Note

Saher S. Sabri is Chief of Interventional Radiology, Medstar Health System and Division Chief of Interventional Radiology at Medstar Georgetown University Hospital

Publication History

Article published online:
29 February 2024

• References

• 1 Pinelli F, Cecero E, Degl'Innocenti D. et al. Infection of totally implantable venous access devices: a review of the literature. J Vasc Access 2018; 19 (03) 230-242
• 2 Pegues D, Axelrod P, McClarren C. et al. Comparison of infections in Hickman and implanted port catheters in adult solid tumor patients. J Surg Oncol 1992; 49 (03) 156-162
• 3 Lebeaux D, Fernández-Hidalgo N, Chauhan A. et al. Management of infections related to totally implantable venous-access ports: challenges and perspectives. Lancet Infect Dis 2014; 14 (02) 146-159
• 4 Ryan JM, Ryan BM, Smith TP. Antibiotic prophylaxis in interventional radiology. J Vasc Interv Radiol 2004; 15 (06) 547-556
• 5 Spies JB, Rosen RJ, Lebowitz AS. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology 1988; 166 (02) 381-387
• 6 Altemeier WA. Manual on Control of Infection in Surgical Patients. Lippincott Williams & Wilkins; 1984
• 7 Venkatesan AM, Kundu S, Sacks D. et al; Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. [corrected] J Vasc Interv Radiol 2010; 21 (11) 1611-1630 , quiz 1631
• 8 Johnson E, Babb J, Sridhar D. Routine antibiotic prophylaxis for totally implantable venous access device placement: meta-analysis of 2,154 patients. J Vasc Interv Radiol 2016; 27 (03) 339-343 , quiz 344
• 9 Karanlik H, Kurul S, Saip P. et al. The role of antibiotic prophylaxis in totally implantable venous access device placement: results of a single-center prospective randomized trial. Am J Surg 2011; 202 (01) 10-15
• 10 Chehab MA, Thakor AS, Tulin-Silver S. et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
• 11 STRIVE Infection Control Training | CDC. Published September 22, 2021 . Accessed January 10, 2023 at: https://www.cdc.gov/infectioncontrol/training/strive.html
• 12 Covey AM, Toro-Pape FW, Thornton RH. et al. Totally implantable venous access device placement by interventional radiologists: are prophylactic antibiotics necessary?. J Vasc Interv Radiol 2012; 23 (03) 358-362
• 13 Munro FD, Gillett PM, Wratten JC. et al. Totally implantable central venous access devices for paediatric oncology patients. Med Pediatr Oncol 1999; 33 (04) 377-381
• 14 Lorenz JM, Funaki B, Van Ha T, Leef JA. Radiologic placement of implantable chest ports in pediatric patients. AJR Am J Roentgenol 2001; 176 (04) 991-994
• 15 Ghmaird AS, Mohammad Alnoaiji MS, Alalawi YS. et al. Port-a-Cath insertion in pediatric patients with malignancy in Tabuk. Cureus 2021; 13 (08) e17379