Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study.
OBJECTIVE
We studied whether the risk of central venous catheter (CVC) -related thrombosis increased after an episode of CVC-related infection in patients undergoing intensive chemotherapy. Secondly, we determined whether thrombosis can be predicted or excluded by CVC lock fluid surveillance cultures.


METHODS
In a prospective setting, 105 consecutive patients were carefully examined for CVC-related infection and thrombosis. In all patients, microbial surveillance cultures of CVC lock fluid were taken every other day. All patients with clinical suspicion of CVC-related thrombosis underwent Doppler ultrasound or additional venography.


RESULTS
The cumulative incidence of CVC-related infection was 24% (25 of 105 patients). Clinically manifest thrombosis occurred in 13 (12%) of 105 patients. In patients with CVC-related infection, the risk of thrombosis increased markedly in comparison to those without infection (relative risk, 17.6; 95% CI, 4.1 to 74.1). In patients having two or more positive subsequent CVC lock fluid cultures with identical micro-organisms, 71.4% developed thrombosis, as compared with 3.3% in patients with negative or a single positive culture.


CONCLUSIONS
The risk of clinically manifest thrombosis is increased after an episode of CVC-related infection in patients undergoing intensive chemotherapy. Surveillance culturing of CVC lock fluid may be clinically useful in estimating the risk for thrombosis and the instigation of focused early intervention.
van Rooden
Cornelis J
CJ
Department of General Internal Medicine, Room C1 R-43, Leiden University Medical Center, 2300 RC Leiden, Netherlands.
Schippers
Emile F
EF
Barge
Renée M Y
RM
Rosendaal
Frits R
FR
Guiot
Henri F L
HF
van der Meer
Felix J M
FJ
Meinders
A Edo
AE
Huisman
Menno V
MV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D001431:Bacteriological Techniques / Q000592:standards; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000209:etiology* / Q000382:microbiology; D018608:Ultrasonography, Doppler