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Treatment of catheter-related bacteremia with tissue plasminogen activator antibiotic locks

Ali Mirza Onder1, Jayanthi Chandar, Nancy Simon

  • 1Division of Pediatric Nephrology, West Virginia University/ Health Sciences Center, P.O. Box 9214, Morgantown, WV 26506-9214, USA. aonder@hsc.wvu.edu

Pediatric Nephrology (Berlin, Germany)
|December 8, 2007
PubMed

Insights

Tissue plasminogen activator antibiotic locks (TPA-ABL) with systemic antibiotics effectively cleared most catheter-related bacteremia (CRB) in pediatric hemodialysis patients. TPA-ABL offers comparable outcomes to catheter exchange for CRB management, preserving vascular access.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Vascular Access Management

Background:

  • Catheter-related bacteremia (CRB) is a significant complication in children undergoing chronic hemodialysis.
  • Effective management strategies are crucial to maintain vascular access and prevent serious infections.

Purpose of the Study:

  • To evaluate the efficacy of tissue plasminogen activator antibiotic locks (TPA-ABL) combined with systemic antibiotics (AB) in clearing CRB in pediatric hemodialysis patients.
  • To compare TPA-ABL treatment outcomes with traditional catheter exchange.

Main Methods:

  • Retrospective study analyzing 76 CRB episodes in 37 children on chronic hemodialysis.
  • Treatment involved TPA-ABL plus systemic AB.
  • Outcomes assessed included CRB clearance, symptomatic infections, need for catheter exchange, and recurrence rates.

Main Results:

  • TPA-ABL/AB successfully cleared CRB in 83% of cases.
  • Gram-positive and gram-negative CRBs were cleared more effectively than polymicrobial CRBs (p < 0.01).
  • Infection-free survival and recurrence rates at 45 days were comparable to catheter exchange, except for symptomatic CRB cases.

Conclusions:

  • TPA-ABL is a safe and effective option for managing CRB in pediatric hemodialysis, enhancing catheter survival.
  • It presents no disadvantage compared to catheter exchange for most CRB types, preserving vascular access sites.
  • Careful consideration is advised for polymicrobial CRB and symptomatic cases due to potential recurrence.

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