Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients?

• Published in: European journal of clinical microbiology & infectious diseases 2013, Vol.32 (1), p.133-138
• Main Authors: Touré, A., Vanhems, P., Lombard-Bohas, C., Souquet, J.-C., Lauverjat, M., Chambrier, C.
• Format: Article
• Language: English
• Subjects: Aged; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Body mass index; Catheter-Related Infections; Catheter-Related Infections - epidemiology; Catheter-Related Infections - mortality; Catheterization, Central Venous; Catheterization, Central Venous - adverse effects; Catheters; Chemotherapy; Diabetes; Diabetes Complications; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Health risks; Hospitals; Human bacterial diseases; Humans; Incidence; Infections; Infectious diseases; Intensive care; Internal Medicine; Life Sciences; Male; Medical instruments; Medical Microbiology; Medical sciences; Medical treatment; Middle Aged; Mortality; Neoplasms; Neoplasms - complications; Pancreatic cancer; Parenteral nutrition; Patients; Risk Assessment; Risk Factors; Sepsis; Sepsis - epidemiology; Sepsis - mortality; Survival Analysis; Venous access
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1728-1

It was a dogma that patients with diabetes mellitus (DM) are at increased risk of infection or death associated with an infection. However, in cancer patients, this has not been well investigated. The aim was to investigate whether diabetic patients with cancer are at high risk of central venous access port (CVAP)-related bloodstream infection (BSI), and to analyse mortality after CVAP-BSI. A total of 17 patients with type 1 DM (T1DM), 66 with type 2 DM (T2DM) and 307 non-diabetic patients were included. Each patient was followed up until the first late CVAP-BSI or for a maximum for 1 year in the absence of a CVAP-BSI. Fifty-three CVAP-BSIs occurred in 66,528 catheter-days. The cumulative incidence of CVAP-BSI was not higher in T1DM (5.9 %; p  = 0.17) and T2DM (19.7 %; p  = 0.70) compared with the non-diabetic patients (12.7 %). However, in patients with CVAP-BSI, the 1-month crude mortality rate was higher in DM patients (42.9 % vs. 15.4 %; p  = 0.04), whereas the mortality in patients without CVAP-BSI was similar in both groups of patients (19.8 % vs. 17.1 %; p  = 0.58). Of the 12 deaths that occurred within 1 month of CVAP-BSI, 16.66 % was attributable to CVAP-BSI. The predictive factor of 1-month mortality was DM ( p  = 0.04). Parenteral nutrition (PN) was independently associated with CVAP-BSI in diabetic patients ( p  = 0.001). In this study, diabetes did not increase the risk of CVAP-BSI, but mortality was higher in diabetic patients who had a CVAP-BSI. This suggests, in addition to medical treatment, CVAP should be withdrawn after infection onset.