Central venous catheter thrombosis during intravenous antibiotic therapy: results of a large cohort study.
Antimicrob Agents Chemother. 2015 Oct 12;
Authors: Guillet S, Zeller V, Dubée V, Ducroquet F, Desplaces N, Horellou MH, Marmor S, Ziza JM
BACKGROUND: Frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (IV) antibiotic therapy have rarely been reported. The primary objective was to evaluate the frequency, incidence and risk factors of CRT among patients being treated with prolonged IV antibiotic therapy. The secondary objective was to describe clinical manifestations, diagnostic evaluation and clinical management.
PATIENTS/METHODS: 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 IV antimicrobial therapy for 2 weeks or more through a CVC were included. Risk factors were identified using non-parametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition.
RESULTS: Eight-hundred and ninety-two patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence 0.39/1000 catheter-days). Median time to CRT was 29 days (12-48). Local clinical signs, fever and secondary complications of CRT were present in 15, 8 and 4 patients, respectively. Median C-reactive protein was 95 mg/l. Treatment combined catheter removal and a median of 3 [1.5-6] months anticoagulation therapy. 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; 1.1-26.6], catheter malposition [OR 5.3; 1.6-17.9] and use of vancomycin [OR 22.9; 2.8-188].
CONCLUSIONS: 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.
PMID: 26459894 [PubMed - as supplied by publisher]