Prevention of coagulase-negative staphylococcal central venous catheter-related infection using urokinase rinses: a randomized double-blind controlled trial in patients with hematologic malignancies.
OBJECTIVE
Fibrin deposition at the intraluminal surface of the indwelling part of the central venous catheter (CVC) surface increases the risk of CVC-related coagulase-negative staphylococci (CoNS) infection. Therefore, repetitive enzymatic dissolution of fibrin by urokinase might reduce the risk of CVC-related infection. We undertook this study to investigate whether three times weekly urokinase rinsing of CVC reduces the incidence or severity of CVC-related infections by CoNS in patients undergoing intensive cytotoxic treatment for hematologic malignancies.


METHODS
In a double-blind setting, all consecutive patients with a CVC were randomly allocated to receive either urokinase rinses (5 mL of 5,000 U/mL) or placebo (saline), both three times weekly.


RESULTS
The percentage of patients with at least one positive culture with CoNS was lower in patients receiving urokinase compared with patients receiving placebo (26% v 42%, respectively; relative risk [RR] = 0.61; 95% CI, 0.39 to 0.94). Major CVC-related CoNS infection occurred less frequently in patients receiving urokinase versus placebo (1.2% v 14.1%, respectively; RR = 0.09; 95% CI, 0.01 to 0.50). Secondary complications, including CVC-related thrombosis, were observed less frequently in the urokinase group compared with the placebo group (1.3% v 9.0%, respectively; RR = 0.14; 95% CI, 0.02 to 0.82). No severe bleeding complications attributable to urokinase were observed.


CONCLUSIONS
Three times weekly urokinase rinsing reduces the incidence of CVC-related CoNS infection in patients treated with intensive cytotoxic therapy for hematologic malignancies, with acceptable safety.
van Rooden
Cornelis J
CJ
Department of General Internal Medicine/Endocrinology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands.
Schippers
Emile F
EF
Guiot
Henri F L
HF
Barge
Renée M
RM
Hovens
Marcel M C
MM
van der Meer
Felix J M
FJ
Rosendaal
Frits R
FR
Huisman
Menno V
MV
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling / Q000382:microbiology*; D003030:Coagulase / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D010919:Placebos; D013203:Staphylococcal Infections / Q000517:prevention & control*; D033581:Stem Cell Transplantation; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000517:prevention & control
D000925:Anticoagulants; D000970:Antineoplastic Agents; D003030:Coagulase; D005343:Fibrinolytic Agents; D010919:Placebos; D014568:Urokinase-Type Plasminogen Activator