title: Venous thrombosis in patients with short- and long-term central venous catheter-associated Staphylococcus aureus bacteremia.
abstract: OBJECTIVE
  Infection and thrombosis are important complications of intravascular catheters. The purpose of this study was to determine the incidence of thrombosis in patients with central venous catheter-associated Staphylococcus aureus bacteremia and the utility of physical examination for diagnosing upper extremity or neck venous thrombosis.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Tertiary care facility.
  
  
  METHODS
  In all, 65 consecutive patients with catheter-associated S. aureus bacteremia with central venous catheters of the internal jugular, brachial, or subclavian veins were eligible for participation.
  
  
  METHODS
  From July 1999 through August 2004, enrolled patients underwent physical examination and ultrasonography independently to identify the presence of catheter-associated thrombosis. Study ultrasonograms were interpreted blindly using defined criteria. Outcomes were defined at 12-wk follow-up.
  
  
  RESULTS
  A total of 48 patients were enrolled. By ultrasonography, definite or possible thrombosis was present in 34 of 48 patients (71%) in this cohort. Death or recurrent bacteremia occurred in 11/34 (32%) infected patients with thrombosis and two of 14 (14%) infected patients without thrombosis (p = .29). Sensitivity of all physical examination findings, either alone or in combination, was low (< or = 24%). Only engorged veins upon hand elevation and the presence of multiple physical examination abnormalities were specific (100% each).
  
  
  CONCLUSIONS
  Thrombosis is a common complication of central venous catheter-associated S. aureus bacteremia. Patients with central venous catheter-associated S. aureus bacteremia should undergo ultrasonography to detect thromboses even if the physical examination is normal.
authors: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. annalisa.crowley@duke.edu
authors: Anna Lisa
authors: AL
authors: Crowley
authors: Gail E
authors: GE
authors: Peterson
authors: Daniel K
authors: DK
authors: Benjamin
authors: Susan H
authors: SH
authors: Rimmer
authors: Cindy
authors: C
authors: Todd
authors: Christopher H
authors: CH
authors: Cabell
authors: L Barth
authors: LB
authors: Reller
authors: Thomas
authors: T
authors: Ryan
authors: G Ralph
authors: GR
authors: Corey
authors: Vance G
authors: VG
authors: Fowler
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply; D010808:Physical Examination; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013211:Staphylococcus aureus; D034941:Upper Extremity / Q000098:blood supply; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology