Diagnostic et traitement des infections liées aux chambres implantables

Totally implanted access port-related infections are responsible for proper complications and mortality. Recent guidelines defined intravascular catheter-related infections but this classification relies on a clinical and microbiological workup including simultaneous culture of blood drawn from the catheter and from a peripheral vein. Clinical and, eventually, echographic evaluation are mandatory in order to assess local or general complications of this infection. Depending on the context and on the type of pathogen, this evaluation can be aggressive including transesophageal echocardiography and search for suppurative thrombosis in case of catheter-related bloodstream infection caused by Staphylococcus aureus. Catheter removal is mandatory in case of local complication (tunnel infection or port pocket abscess), septic thrombosis, infective endocarditis, osteomyelitis, septic shock or infection related to specific pathogens (S. aureus, Candida spp., Pseudomonas aeruginosa). Otherwise, retention of the catheter might be proposed given results from recent studies including antibiotic lock therapy associated with systemic antibiotic. Future prospects must focus on defining more precisely factors associated with salvage therapy failure including host, pathogens virulence factors and biofilm formation.