title: The role of tissue plasminogen activator use and systemic hypercoagulability in central line-associated bloodstream infections.
abstract: BACKGROUND
  Central line-associated bloodstream infections (CLABSIs) impact patient outcomes and increase cost of hospitalization. In situ thrombus is known to promote microbial adhesion and colonization and potentially lead to CLABSI. Clinical validation of this theory, adjusting for presence of systemic hypercoagulability, is needed.
  
  
  METHODS
  This study is a retrospective review of all adult and pediatric patients with peripherally inserted central catheter placement over a 4-year period at our tertiary care center. Tissue plasminogen activator (TPA) use was utilized as indicator for line site thrombus. CLABSIs rates were compared in patients with or without TPA use, adjusting for the presence of hypercoagulable conditions, age, and severity of illness.
  
  
  RESULTS
  A total of 3,723 patients with peripherally inserted central catheter lines was evaluated, 40% of whom received TPA. The adjusted odds of developing a CLABSI was 3.59 times greater in those patients who received TPA compared with those who did not (95% confidence interval [CI]: 1.86-6.94). Neither severity of illness (odds ratio [OR], 1.00; 95% CI: 0.51-1.96) nor primary (OR, 3.41; 95% CI: 0.43-26.7) or secondary hypercoagulability (OR, 0.91; 95% CI: 0.44-1.88) were statistically associated with a higher risk of infection.
  
  
  CONCLUSIONS
  The use of TPA, as a possible indicator in situ thrombus, was associated with a higher risk of developing CLABSI. Neither primary nor secondary hypercoagulability was correlated with risk of developing CLABSI.
authors.affiliation: Section of Infectious Diseases, Boston Medical Center, Boston, MA.
authors.forename: Kinna
authors.initials: K
authors.lastname: Thakarar
authors.affiliation: Department of Medicine, Boston Medical Center, Boston, MA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Collins
authors.affiliation: Department of Quality Improvement, Boston Medical Center, Boston, MA.
authors.forename: Lana
authors.initials: L
authors.lastname: Kwong
authors.affiliation: Section of Infectious Diseases, Boston Medical Center, Boston, MA.
authors.forename: Carol
authors.initials: C
authors.lastname: Sulis
authors.affiliation: Department of Infection Control, Boston Medical Center, Boston, MA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Korn
authors.affiliation: Section of Infectious Diseases, Boston Medical Center, Boston, MA. Electronic address: nbhadeli@bu.edu.
authors.forename: Nahid
authors.initials: N
authors.lastname: Bhadelia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000150:complications*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D019851:Thrombophilia / Q000453:epidemiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Health care associated infection; Health care epidemiology; Medical device infections; Vascular thrombosis