Impact de la nutrition parentérale associée à la chimiothérapie intraveineuse sur l'incidence des infections aux cathéters veineux chez les patients ayant un cancer digestif

Abstract : Central venous catheters are commonly used in cancer patients for administration of chemotherapy, hydration, parenteral nutrition and antibiotic. However, their use is associated with complications such as infections. An often serious complication is bloodstream infections. This can cause a suspending of cancer treatment. Central venous catheter-related bloodstream infections also contribute to increased mortality in theses patients. The incidence rates and CVC-RBSI risk factors are not well known in patients with cancer. Then in a prospective study conducted during 5 years, we have analysed data from 425 patients with digestive cancer. Study took place at Edouard Herriot Hospital and Croix Rousse Hospital in Lyon. First, we estimated rate of CVC-RBSI according to the location of primary cancer. To the best estimation of parenteral nutrition effect on the risk of CVC-RBSI, we performed the propensity score analysis, which can mimic some characteristics of randomized trial. Finally, we analyzed the 30-day mortality after CVC-BSI. The results showed that the infection rate was higher in pancreatic and oesophageal cancer patients, compared with colorectal cancer patients. The risk factors independently associated with CVC-RBSI were pancreatic cancer, performance status, cumulative catheter utilization-days and parenteral nutrition. The risk of CVC-RBSI was at least 5 times greater in patients with parenteral nutrition. Attributable mortality rate within 1 month of CVC-RBSI was 16.6%. Diabetes mellitus was independently associated with death.
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Abdoulaye Ii Toure. Impact de la nutrition parentérale associée à la chimiothérapie intraveineuse sur l'incidence des infections aux cathéters veineux chez les patients ayant un cancer digestif. Médecine humaine et pathologie. Université Claude Bernard - Lyon I, 2012. Français. ⟨NNT : 2012LYO10282⟩. ⟨tel-00976860⟩

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