Treatment of an infected silicone right atrial catheter with combined fibrinolytic and antibiotic therapy: case report and review of the literature.
Tunnelled silicone rubber right atrial catheters are commonly used to administer long-term total parenteral nutrition (TPN), cancer chemotherapeutic agents, and antimicrobial agents. The indwelling devices potentiate platelet-fibrin thrombi formation, providing a nidus for infection. Although many episodes of sepsis associated with thrombotic tunnelled catheters respond to antimicrobial therapy alone, a significant number require catheter removal. Evidence from case studies and small clinical trials suggests that fibrinolytic agents may increase the response rate and prevent removal of the device when combined with antimicrobial therapy. We present the first case reported of bacterial sepsis secondary to a thrombotic indwelling Hickman catheter for long-term TPN successfully treated with a combination of streptokinase and antibiotic therapies.
Lewis
J A
JA
College of Pharmacy, Department of Pharmacy, University of Cincinnati, Ohio.
LaFrance
R
R
Bower
R H
RH
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004866:Equipment Contamination; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000295:instrumentation*; D012826:Silicone Elastomers; D013300:Streptokinase / Q000008:administration & dosage* / Q000627:therapeutic use; D013924:Thrombophlebitis / Q000188:drug therapy / Q000209:etiology
D000900:Anti-Bacterial Agents; D012826:Silicone Elastomers; D013300:Streptokinase