What is the treatment for an infected port?

Treatment of Infected Ports

The treatment of infected ports requires catheter removal in cases of tunnel infections, port abscesses, severe sepsis, persistent hemodynamic instability, or bloodstream infections with fungi, while a conservative approach with systemic and local antibiotics can be attempted for uncomplicated infections with coagulase-negative staphylococci. 1, 2

Diagnosis of Port Infection

• Obtain blood cultures before starting antibiotic therapy, with paired samples from the catheter and a peripheral vein 2
• Use alcohol, iodine tincture, or alcoholic chlorhexidine (2%) for skin preparation before collection 2, 1
• Differential time to positivity (DTP) can help confirm catheter-related infection, with growth from catheter hub at least 2 hours before peripheral sample 1
• Assess for clinical signs of infection including fever, erythema, tenderness, or drainage at the port site 3

Treatment Algorithm

Immediate Management

• Start parenteral antibiotic therapy immediately when infection is suspected, without waiting for culture results 2
• Initial empirical coverage should include vancomycin for gram-positive organisms (particularly MRSA) 3, 4
• For critically ill patients, add coverage for gram-negative organisms 2

Decision for Port Removal vs. Salvage

Mandatory Port Removal for:

• Tunnel infections or port pocket infections/abscesses 1
• Severe sepsis or persistent hemodynamic instability 1, 2
• Bloodstream infections with fungi (e.g., Candida species) 1, 2
• Bloodstream infections with S. aureus 1, 2
• Complicated infections including endocarditis, metastatic infections, septic thrombosis 1
• Infections that persist despite 72 hours of appropriate antibiotic therapy 1

Catheter Salvage May Be Attempted for:

• Uncomplicated infections with coagulase-negative staphylococci 1, 2
• Situations where catheter removal poses significant risks 2
• When using antibiotic lock therapy in addition to systemic antibiotics 2

Antibiotic Treatment

• For uncomplicated infections with device removal: 10-14 days of antibiotic therapy 2
• For tunnel infection or port abscess requiring device removal: 7-10 days of antibiotic therapy 2
• For complicated infections: 4-6 weeks for septic thrombosis or endocarditis 2
• When attempting salvage, use both systemic antibiotics and antibiotic lock therapy 1, 2

Antibiotic Lock Therapy (for Salvage Attempts)

• Treatment duration should be 7-14 days 2
• Dwell time ideally ≥12 hours 2
• High concentration of an antibiotic to which the causative microbe is susceptible 1

Special Considerations

• Success rates for port salvage are lower with S. aureus infections (67%) compared to coagulase-negative staphylococci (92%) 5
• Risk factors for port infection include male sex, low BMI (≤20 kg/m²), and use for total parenteral nutrition 6
• In pediatric hematology-oncology patients, port-associated bloodstream infections may be successfully treated without device removal in many cases 5
• Patients with short bowel syndrome and difficulty with oral intake are at higher risk for port infections 6

Prevention of Port Infections

• Education of staff and patients/caregivers 1
• Proper handwashing and disinfection before touching central venous catheters 1
• Disinfection of the hub connector every time it is accessed 1
• Use of chlorhexidine 2% for antisepsis of hands, catheter exit site, and other access points 1
• Regular cleaning of the catheter site and hub on at least a weekly basis 1
• Taurolidine catheter locks may be used in carefully selected patients with recurrent infections 1