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Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections
Courtney M Rowan1, Kathryn E Miller, Andrew L Beardsley
1Pediatric Pulmonary, Critical Care, and Allergy, Riley Hospital for Children, Indianapolis, IN, USA.
Insights
Catheter thrombosis increases the risk of catheter-associated bloodstream infections (CBSIs) in pediatric patients. Alteplase use for malfunctioning catheters correlates with a higher incidence of CBSIs, suggesting a link with thrombus formation.
Area of Science:
- Medical Research
- Pediatric Critical Care
- Infectious Diseases
Background:
- Catheter thrombosis and catheter-associated bloodstream infections (CBSIs) frequently coexist.
- Studies suggest a link between fibrin sheaths, thrombi, and CBSI development in adults and animals.
- Limited pediatric data exists on the relationship between thrombus and bacteremia.
Purpose of the Study:
- To investigate the correlation between central venous catheter (CVC) malfunction treated with alteplase and the incidence of CBSIs in a pediatric intensive care unit (PICU).
- To determine if alteplase use, indicative of intraluminal thrombus or fibrin sheath, increases CBSI risk in pediatric patients.
Main Methods:
- Retrospective chart review of CVCs in a PICU from July 2008 to December 2010.
- Analysis of the number of CVCs requiring alteplase treatment and the number of CBSIs.
- Calculation of odds ratio for CBSI in catheters treated with alteplase.
Main Results:
- Out of 3,289 CVCs, 12% required alteplase.
- 28% of 40 CBSIs occurred in catheters treated with alteplase within 5 days prior to positive blood culture.
- The odds of developing a CBSI when alteplase is administered is 2.87 (p = 0.002).
Conclusions:
- A positive correlation exists between alteplase use for malfunctioning CVCs and CASBI development.
- This association is likely due to intraluminal fibrin sheath or thrombus formation.
- The study provides evidence linking thrombus formation to CBSIs in pediatric patients.
Objectives:
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.
Design:
A retrospective chart review from July 2008 to December 2010.
Setting:
PICU.
Patients:
All patients with central catheters admitted to the PICU.
Interventions:
No interventions performed with the retrospective study.
Measurements:
Number of total central venous catheters, number of central venous catheters that received treatment with alteplase, and number of CBSIs.
Main 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.
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