title: Updated analysis: central venous access device infection rates in an expanded cohort of paediatric patients with severe haemophilia receiving prophylactic recombinant tissue plasminogen activator.
abstract: BACKGROUND
  Central venous access devices (CVADs) are used in the care of paediatric haemophilic patients with difficult peripheral access, but their use is limited by complications such as infection. We previously published our experience with monthly recombinant tissue plasminogen activator (r-tPA) administration to CVADs of haemophilic patients as an intervention for infection prophylaxis, which suggested a 10-fold decrease in infection rate compared to published rates without r-tPA.
  
  
  OBJECTIVE
  This study was conducted to assess the CVAD infection rate in an expanded haemophilia cohort receiving r-tPA over an extended period.
  
  
  METHODS
  A retrospective review was performed on patients with haemophilia who received monthly r-tPA to CVADs, with data collected from January 1, 2008 to December 31, 2012. The data were merged with the previously reported data set (collected from June 1, 1998 to December 31, 2007).
  
  
  RESULTS
  Over the entire observation period, there were 46 350 CVAD days among 32 patients [26 severe factor VIII (FVIII) deficiency, six severe FIX deficiency]. Eight patients received immune tolerance therapy for inhibitors and 24 patients received prophylactic factor administration. No patients were HIV positive. Three infections were observed, with an overall infection rate of 0.06 infections per 1000 CVAD days.
  
  
  CONCLUSIONS
  A low CVAD infection rate, similar to that observed in our previous study (0.04 per 1000 CVAD days), was observed in this expanded haemophilia cohort treated with prophylactic r-tPA, supporting the use of monthly r-tPA as CVAD infection prophylaxis in haemophilia patients.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: McCarthy
authors.affiliation: Cancer and Blood Disorders Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.|Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Zoland
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Macasiray
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lo
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.|Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Glader
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tamaresis
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Jeng
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000150:complications / Q000209:etiology*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055595:Mechanical Phenomena; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: central venous catheter; haemophilia; infection prophylaxis; recombinant tissue plasminogen activator