Date of Award

January 2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Igor Latich

Abstract

Purpose

To evaluate the effectiveness of pre-procedural single-dose IV antibiotics during port placement in preventing procedure-related infections, and to identify clinical and technical contributing factors.

Material and methods

This was a single-institution, IRB-approved study evaluating short-term (30-day) infection outcomes after the placement of a chest port. Correlation between infection rate and clinical factors, including hematologic vs. non-hematological malignancy, in-patient vs. outpatient status, and administration of prophylactic pre-procedural IV antibiotics was investigated. Additionally, correlation between infection rate and technical factor such as device type (single vs. double lumen) was evaluated. Chi-squared and Fisher exact tests were used for statistical analysis where applicable.

Results

Overall, 5,967 ports were placed between 2005 and 2016. Of the 3,978 (67%) patients who received prophylactic antibiotics, 94% (3,757/3,978) received cefazolin. Port removal due to infection concern was performed in 48 patients, with no statistically significant difference in the rate of infection between those who received antibiotics (0.85%, 34/3,978) vs. those who did not (0.70%, 14/1,989; p=0.5387). There was a statistically significant higher rate of infection in patients who had their port placed as an inpatient (p<0.0001), as well as in patients who received a double lumen port (p<0.0001), and in those with hematologic malignancy (p=0.0004). However, there was no statistical difference in infection rate between those who received antibiotic prophylaxis vs. those who did not for patients who: had a double lumen port placed (p=0.6704), were inpatient (p=0.3945), or had a hematologic malignancy (p=0.4683). Furthermore, inpatients and outpatients were equally likely to be administered prophylactic antibiotics during TIVAP placement (OR=1.0693, 0.95 CI [0.9393,1.2173]). In addition, PABX had no effect on timing of port removal, meaning the port was equally likely to be removed for infection within first or last 2 weeks irrespective of antibiotic treatment (p=0.1146).

Conclusion

Single dose of pre-procedural antibiotics does not appear to prevent short-term procedure-related infections.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100

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