Complications and risk factors of infection in pediatric hemato-oncology patients with Totally Implantable Access Ports (TIAPs)

Abstract

Background. Totally implantable access ports (TIAPs) are widely used in pediatric hematology-oncology patients. We investigated the incidence of complications, causes of TIAP removal, and risk factors for infection. Procedure. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 225 pediatric hematology - oncology patients implanted with 238 TIAPs between January 2004 and December 2005. Results. Except for 20 patients lost to follow-up, the mean maintenance period was 724.8 ± 500.6 days (range: 17-2,124). Mechanical complications occurred in seven patients (2.9%). The causes of TIAP removal were termination of use in 130 patients (59.6%), death from primary disease with TIAP in situ in 35 (14.7%), infection in 35 (14.7%), and obstruction in 4 (1.8%). Early infections occurred in nine patients at mean 37.77 ± 16.44 days (range: 17-56). Late infections occurred in 26 patients at mean 334.5 ± 257.82 days (range: 68-997). Univariate analysis showed that the risk factors of early infection were reimplantation (P=0.022) and long operation time (P=0.045). The risk factors of late infection were ANC <500/mm3 (P=0.011) and platelet count <50,000/mm3 (P<0.001). In multivariate analysis, reimplantation was a significant risk factor of early infection (P=0.033, OR 4.528) and low platelet count (<50,000/mm3) was the independent risk factor for late infection (P=0.005, OR 4.24). Conclusions. Correct procedure and careful use decreases the incidence of early infection and leads to the prevention of re-implantation. Initial thrombocytopenia was attributable to bone marrow suppression caused by hematologic malignancies or severe infection. Thus, this condition is of value in predicting late infection. © 2009 Wiley-Liss, Inc.