Venous thrombosis in patients with short- and long-term central venous catheter-associated Staphylococcus aureus bacteremia.
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.
Crowley
Anna Lisa
AL
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. annalisa.crowley@duke.edu
Peterson
Gail E
GE
Benjamin
Daniel K
DK
Rimmer
Susan H
SH
Todd
Cindy
C
Cabell
Christopher H
CH
Reller
L Barth
LB
Ryan
Thomas
T
Corey
G Ralph
GR
Fowler
Vance G
VG
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