title: Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections.
abstract: OBJECTIVE
  A catheter thrombosis and the presence of a catheter-associated bloodstream infection (CBSI) often occur simultaneously, but it is unclear if or to what degree the two complications relate. Several animal and adult studies indicate a relationship between fibrin sheaths and thrombi in the development of CBSIs. To date, there has been limited human investigation in the pediatric population to determine a clear link between the presence of a thrombus and bacteremia. The use of alteplase for malfunctioning central venous catheter may indicate the formation of intraluminal thrombus or fibrin sheath. A catheter that requires alteplase is at higher risk of a CBSI.
  
  
  METHODS
  A retrospective chart review from July 2008 to December 2010.
  
  
  METHODS
  PICU.
  
  
  METHODS
  All patients with central catheters admitted to the PICU.
  
  
  METHODS
  No interventions performed with the retrospective study.
  
  
  METHODS
  Number of total central venous catheters, number of central venous catheters that received treatment with alteplase, and number of CBSIs.
  
  
  RESULTS
  Preliminary data during the study period identified 3,289 central venous catheters. Twelve percent of these catheters required at least one dose of alteplase. There were 40 CBSIs during this same time period of which 28% received alteplase during the 5 days preceding the positive blood culture. The odds ratio for getting a CBSI when alteplase is administered is 2.87 (confidence interval 1.42-5.80; p = 0.002). The average age of the central venous catheters at time of infection was not statistically different, 16.1 days in the alteplase catheters compared with 25.6 days for the catheters that did not receive alteplase (p = 0.6).
  
  
  CONCLUSIONS
  There is a positive correlation between the use of alteplase for malfunctioning central venous catheters and the development of a CASBI. This is likely associated with the presence of an intraluminal fibrin sheath or thrombus. This study adds evidence linking thrombus formation to CBSI.
authors: Pediatric Pulmonary, Critical Care, and Allergy, Riley Hospital for Children, Indianapolis, IN, USA.
authors: Courtney M
authors: CM
authors: Rowan
authors: Kathryn E
authors: KE
authors: Miller
authors: Andrew L
authors: AL
authors: Beardsley
authors: Sheikh S
authors: SS
authors: Ahmed
authors: Luis A
authors: LA
authors: Rojas
authors: Terri L
authors: TL
authors: Hedlund
authors: Richard H
authors: RH
authors: Speicher
authors: Mara E
authors: ME
authors: Nitu
mesh_terms: D061807:Catheter Obstruction / Q000209:etiology*; D055499:Catheter-Related Infections / Q000209:etiology*; D002405:Catheterization, Central Venous; D002648:Child; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D016017:Odds Ratio; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000150:complications* / Q000188:drug therapy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator