title: Comparison of tissue plasminogen activator-antibiotic locks with heparin-antibiotic locks in children with catheter-related bacteraemia.
abstract: BACKGROUND
  An accepted pathogenesis of catheter-related bacteraemia (CRB) is the seeding of microorganisms from the intraluminal biofilm of central venous catheters. Antibiotic locks (ABL) are solutions containing high concentrations of antimicrobials with or without anticoagulants that aim to destroy the biofilm.
  
  
  METHODS
  In this study, two different ABL solutions, tissue plasminogen activator (TPA)-based and heparin-based ABL, used in conjunction with systemic antibiotics, were prospectively compared in the treatment of CRB.
  
  
  RESULTS
  A total of 42 children on chronic haemodialysis with 11,016 catheter-days were observed for signs and symptoms of CRB over a period of 10 months. Twenty-four CRBs were diagnosed in 18 children (2.2 CRB/1000 catheter-days) and were treated with the protocol. Symptoms of CRB resolved in 83% within 48 h of treatment. None of the infected catheters required early emergent exchange or removal for poorly controlled CRB. Six children had recurrence of CRB within 6 weeks, of which four required catheter exchange. There was no specific microorganism or type of CRB that predisposed to higher recurrence rates. The mean infection-free survival of the catheters following TPA-ABL treatment was shorter than that following heparin-ABL treatment, but was not statistically significant by the log-rank test (126.8 +/- 81.6 days versus 154.5 +/- 70.4 days).
  
  
  CONCLUSIONS
  Both TPA-ABL and heparin-ABL used in conjunction with systemic antibiotics can effectively clear CRB without significant late recurrence at 6 weeks. Early use of ABL for management of CRB can potentially decrease the need for catheter removal, thus salvaging vascular access sites.
authors.affiliation: Division of Paediatric Nephrology, Department of Paediatrics, West Virginia University, WV, USA.
authors.forename: Ali Mirza
authors.initials: AM
authors.lastname: Onder
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: Nancy
authors.initials: N
authors.lastname: Simon
authors.forename: Rosa
authors.initials: R
authors.lastname: Diaz
authors.forename: Obioma
authors.initials: O
authors.lastname: Nwobi
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Abitbol
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D018441:Biofilms / Q000187:drug effects; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014031:Tobramycin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D014640:Vancomycin; D006493:Heparin; D010959:Tissue Plasminogen Activator; D014031:Tobramycin