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Abstract
Background: Urokinase plasminogen activator was used in combination with antibiotic therapy given
through the catheter to improve the treatment of right atrial catheter infections.
Methods: One hundred fifty-four episodes of bacteremia and candidemia occurring in 97 children
with malignant or hematologic conditions were treated. After 24 hours of antibiotic
therapy, 1 ml urokinase (5000 units/ml) was instilled, dwelling 1 hour, and then removed;
this was repeated within 24 hours. Antibiotic therapy was continued for 10 to 35 days.
Administration of urokinase was repeated once if infection recurred within 8 weeks
of initial treatment.
Results: There were no adverse affects from administration of urokinase. Bacteremia clearance
failed after initial administration of urokinase in 12 episodes; this failure was
mostly associated with the presence of gram-positive organisms. Blood culture results
remained positive in three cases after repeat therapy. Bacteremia recurrent in 15
of 125 episodes; in three cases bacteremia did not clear after repeat administration
of urokinase or recurred again. Recurrence was lowest for gram-negative organisms
and Candida sp. Less than 5% of catheters were removed as a result of treatment failure.
Conclusions: Administration of urokinase combined with antibiotic therapy is safe and may be effective
in treating bacteremia and candidemia in patients with right atrial catheters. Use
of urokinase may improve treatment of organisms that are otherwise difficult to control
and may prevent recurrence of infection.
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© 1996 Published by Elsevier Inc.
