Document Detail


A prospective randomized trial of urokinase as an adjuvant in the treatment of proven Hickman catheter sepsis.
MedLine Citation:
PMID:  9607475     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: Chronic vascular access catheters have become an important adjunct to the treatment of children with complex medical diseases, particularly malignancy. One of the major complications of chronic venous access devices is bacterial infection of the catheter site and bloodstream. Infusion of systemic antibiotics directly into the catheter has been the standard initial therapy with failure leading to catheter removal and replacement. It has been suggested by a number of investigators that the addition of urokinase as a thrombolytic agent to lyse any accumulated thrombus or fibrin would increase the successful catheter clearance by antibiotics. This study was designed as a prospective, randomized trial to compare treatment of children with positive catheter blood cultures with either antibiotics alone or in combination with urokinase 5,000 U boluses 12 and 24 hours after study entry. METHODS: A total of 63 patients were entered in the study. Thirty-three received antibiotics and urokinase, and 30 received antibiotics alone. RESULTS: A total of 45 catheters (71%) were cleared of infection and salvaged. Treatment failures leading to catheter removal occurred in 9 of 33 in the experimental group and 9 of 30 in the control population (no significant difference). CONCLUSIONS: Urokinase could not be shown to act as an adjuvant in the clearance of infection from chronic central venous access catheters that had no evidence of clot or thrombus. This study required the performance of a dye study and excluded any patient with a known thrombus. This conclusion must therefore be limited to patients with no evidence of a clot or fibrin sheath.
Authors:
J B Atkinson; K Chamberlin; B A Boody
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  33     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-07-30     Completed Date:  1998-07-30     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  714-6     Citation Subset:  IM    
Affiliation:
Department of Surgery/Pediatrics, UCLA School of Medicine, Los Angeles, CA 90095-1749, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / therapeutic use*
Bacteremia / drug therapy*,  etiology
Bacterial Infections / drug therapy*,  etiology
Catheters, Indwelling / adverse effects*
Child
Child, Preschool
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Plasminogen Activators / therapeutic use*
Prospective Studies
Treatment Outcome
Urokinase-Type Plasminogen Activator / therapeutic use*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.73/Urokinase-Type Plasminogen Activator

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