A prospective randomized trial of urokinase as an adjuvant in the treatment of proven Hickman catheter sepsis
A prospective randomized trial of urokinase as an adjuvant in the treatment of proven Hickman catheter sepsis
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DOI：
10.1016/s0022-3468(98)90194-4
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发表时间：
1998-05-01
影响因子：
2.4
通讯作者：
Boody, BA
中科院分区：
文献类型：
--
作者：
Atkinson, JB;Chamberlin, K;Boody, BA
背景/目的：慢性血管通路导管已成为治疗儿童复杂内科疾病，特别是恶性肿瘤的重要辅助手段。慢性静脉置管装置的主要并发症之一是导管部位和血流的细菌感染。直接向导管内注入全身抗生素一直是标准的初始治疗方法，但失败后会导致导管取出和更换。一些研究人员提出，加入尿激酶作为溶栓剂来溶解任何积聚的血栓或纤维蛋白将增加抗生素对导管的成功清除。这项研究是一项前瞻性随机试验，目的是在研究进入后12小时和24小时比较单独使用抗生素或联合应用尿激酶5,000 U静脉滴注对导管血培养阳性儿童的治疗效果。33例使用抗生素和尿激酶，30例仅使用抗生素。结果：45根导管(71%)清除感染并抢救成功。试验组33例中有9例治疗失败，对照组30例中有9例治疗失败(无显著差异)。结论：尿激酶不能作为清除无血栓或血栓证据的慢性中心静脉置管感染的辅助手段。这项研究需要进行染料研究，排除了所有已知血栓的患者。因此，这一结论必须局限于没有血栓或纤维蛋白鞘证据的患者。版权所有(C)1998年，W.B.桑德斯公司。
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. Copyright (C) 1998 by W.B. Saunders Company.