1626 - Chlorhexidine for the prevention of bloodstream infection (BSI) associated with permanently implantable venous ports (port-a) in solid cancer patien...

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Supportive Care
Presenter Hsiang-Fong Kao
Authors H. Kao1, I. Chen1, S. Chang2, M. Hong2, S. Chien3, F. Hu4, C. Hsu5, K. Yeh6
  • 1Department Of Oncology, National Taiwan University Hospital, Yun-Lin Branch, 63247 - Yunlin/TW
  • 2Department Of Nursing, National Taiwan University Hospital, 10002 - Taipei/TW
  • 3Center For Infection Control, National Taiwan University Hospital, 10002 - Taipei/TW
  • 4Graduate Institute Of Clinical Medicine, National Taiwan University College of Medicine, 10051 - Taipei/TW
  • 5National Taiwan University Hospital, 10002 - Taipei/TW
  • 6Oncology Dept., National Taiwan University Hospital, TW-100 - Taipei/TW

Abstract

Background

Chlorhexidine can prevent surgical wound infection and BSI related to central venous catheters, but its effects on preventing BSI associated with Port-A use in cancer patients remain obscure.

Methods

Solid cancer patients who were implanted with a Port-A since Dec 2010 at our department for systemic anti-cancer therapies were prospectively followed for the occurrence of Port-A-associated BSI (PABSI), defined as BSI without other identifiable infection foci. All patients used chlorhexidine for Port-A topical care. The time to first PABSI in this cohort was compared with a previous cohort for whom iodine was used as topical anti-septic. Risk factors of PABSI were analyzed by Cox proportional hazards model.

Results

The baseline characteristics of the two cohorts were similar (table). The PABSI incidence was 0.740 and 1.051 per 1000 catheter-day for the chlorhexidine and the iodine cohorts, respectively. The use of chlorhexidine can significantly delay the time to first Gram-positive-cocci (GPC) PABSI (hazard ratio (HR) 0.41, 95% CI 0.20-0.84, p = 0.015). Other Independent predictors of increased GPC PABSI occurrence included previous chemotherapy (HR = 13.65, 95% CI = 4.12-45.26), total parental nutrition (HR =5.17, 95% CI = 2.51-10.63), chronic steroid use (HR = 7.02, 95% CI = 2.60-18.90), and postoperative antibiotics (HR = 2.06, 95% CI = 1.02-4.14). Chlorhexidine had no significant effects on preventing Gram-negative bacilli or fungal PABSI.

Conclusion

The use of chlorhexidine as topical anti-septic may help prevent GPC-related PABSI in cancer patients.

(supported by grants NTUH 100-S1805)

Iodine chlorhexidine p value
Enrollment Oct 2009-Aug 2010 Dec 2010-Nov 2011
N 396 487
M/F 202/194 242/245 0.697
median age 57.7 59.1 0.121
Cancer type 0.892
GI 169 209
Lung 115 129
Breast 46 71
H&N cancer + NPC 20 26
Others 46 52
N of stage IV 324 (0.82) 376 (0.77) 0.136
Total catheter-day 81752 99977

Disclosure

All authors have declared no conflicts of interest.