Treatment of catheter-related bacteremia with tissue plasminogen activator antibiotic locks.
This retrospective study was completed to investigate the effectiveness of tissue plasminogen activator (TPA) antibiotic locks (ABL) along with systemic antibiotics (AB) to clear catheter-related bacteremia (CRB) in children on chronic hemodialysis. There were 76 CRBs in 37 children. CRBs were successfully cleared with AB/ABL in 63/76 (83%) cases. Ten of 76 (13%) CRBs were symptomatic at 48 h of treatment. These were seven polymicrobial, two gram-negative, and one Candida CRB. 13/76 (17%) episodes required catheter exchange, and all were wire-guided exchanges. TPA-ABL/AB cleared gram-positive and gram-negative CRBs significantly better than polymicrobial CRBs (p < 0.01). The infection-free survival and the rate of recurrence at 45 days was not statistically different between the TPA-ABL/AB group and the catheter-exchange group. If CRB was symptomatic at 48 h of treatment, recurrence at 6 weeks was more frequent with persistent use of TPA-ABL/AB (p < 0.05). There were no episodes of metastatic infections, catheter malfunction from occlusion, or catheter breakdown during the course of TPA-ABL treatments. In conclusion, TPA-ABL can be safely and effectively used in the management of CRB, increasing the probability of catheter survival and preserving the vascular access site. With the exception of polymicrobial CRB, there is no disadvantage in using TPA-ABL/AB over catheter exchange, as the infection-free survival and the rate of recurrence are comparable.
Division of Pediatric Nephrology, West Virginia University/ Health Sciences Center, P.O. Box 9214, Morgantown, WV 26506-9214, USA. aonder@hsc.wvu.edu
Ali Mirza
AM
Onder
Jayanthi
J
Chandar
Nancy
N
Simon
Marie
M
Saint-Vil
Denise
D
Francoeur
Obioma
O
Nwobi
Carolyn
C
Abitbol
Gaston
G
Zilleruelo
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology*; D002404:Catheterization / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014031:Tobramycin / Q000008:administration & dosage*; D014640:Vancomycin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D010959:Tissue Plasminogen Activator; D014031:Tobramycin