Atkinson J B, Chamberlin K, Boody B A
Department of Surgery/Pediatrics, UCLA School of Medicine, Los Angeles, CA 90095-1749, USA.
J Pediatr Surg. 1998 May;33(5):714-6. doi: 10.1016/s0022-3468(98)90194-4.
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.
A total of 63 patients were entered in the study. Thirty-three received antibiotics and urokinase, and 30 received antibiotics alone.
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).
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.
背景/目的：长期血管通路导管已成为治疗患有复杂疾病尤其是恶性肿瘤儿童的重要辅助手段。长期静脉通路装置的主要并发症之一是导管部位和血流的细菌感染。将全身用抗生素直接注入导管一直是标准的初始治疗方法，若治疗失败则导致导管拔除和更换。一些研究人员提出，添加尿激酶作为溶栓剂以溶解任何积聚的血栓或纤维蛋白，会提高抗生素清除导管感染的成功率。本研究设计为一项前瞻性随机试验，比较在研究开始后12小时和24小时分别给予5000单位尿激酶推注联合抗生素与单纯使用抗生素治疗导管血培养阳性儿童的效果。
共有63例患者纳入本研究。33例接受抗生素加尿激酶治疗，30例仅接受抗生素治疗。
共有45根导管（71%）感染清除并得以保留。试验组33例中有9例因治疗失败导致导管拔除，对照组30例中有9例（无显著差异）。
对于没有血栓或凝块证据的长期中心静脉通路导管，尿激酶不能作为清除感染的辅助药物。本研究需要进行染料研究，并排除任何已知有血栓的患者。因此，这一结论必须局限于没有凝块或纤维蛋白鞘证据的患者。
