Pathogen-specific salvage of totally implantable ports and the role of antibiotic lock therapy

This is the authors' abstract. We don't add key points for this paper.

Purpose Totally implantable venous-access ports (TIPs) are central to cancer therapy, but bloodstream infection (BSI) frequently ends in device loss. Device retention rests on systemic antibiotic therapy, to which antibiotic lock therapy (ALT) can be added, yet the determinants of successful salvage in adults are poorly defined. This study examined which TIP infections can be salvaged. Methods 233 consecutive episodes of TIP-related BSI at a tertiary cancer centre (2017–2020) were analysed retrospectively. The primary outcome was successful TIP salvage: retention of a functioning device with clinical cure. Determinants were assessed by logistic regression and salvage across protocol-defined pathogen categories was tested for trend. Results Isolates were Gram-positive in 58%, Gram-negative in 38% and fungal in 4%; 19% polymicrobial. The TIP was salvaged in 68/225 episodes (30%); primary explantation commonest (53%). Salvage fell across the protocol categories: coagulase-negative staphylococci 41%, Gram-negative bacilli/enterococci/other Gram-positives 35%, S. aureus / P. aeruginosa/Candida 2% (P for trend < 0.001). Independent predictors were a high-virulence pathogen (adjusted odds ratio 0.04, 0.01–0.30) and a peripheral arm port (0.29, 0.13–0.65); no comorbidity or severity factor was robustly associated with salvage. ALT, attempted in 79/221 episodes (36%), was not associated with higher salvage among retention attempts (55% vs. 68% with systemic antibiotics alone, odds ratio 0.57, 0.25–1.29). Conclusion TIP salvage was associated with the infecting organism. The pathogen gradient mirrored guideline-based removal recommendations. About 60% of attempted retentions succeeded, without detectable benefit of ALT. With a pathogen-stratified protocol, salvage can be attempted in selected patients.