title: Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy.
abstract: The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ≥2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified.
authors.affiliation: Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Guillet
authors.affiliation: Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France vzeller@hopital-dcss.org.
authors.forename: Valérie
authors.initials: V
authors.lastname: Zeller
authors.affiliation: Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dubée
authors.affiliation: Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Service d'Anesthésie et Réanimation, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Ducroquet
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Desplaces
authors.affiliation: Laboratoire d'Hématologie Biologique, Hôpital Cochin, Paris, France.
authors.forename: Marie Hélène
authors.initials: MH
authors.lastname: Horellou
authors.affiliation: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Marmor
authors.affiliation: Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Ziza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D001850:Bone Diseases, Infectious / Q000188:drug therapy; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D014640:Vancomycin; D002097:C-Reactive Protein