The role of tissue plasminogen activator use and systemic hypercoagulability in central line-associated bloodstream infections

Abstract

Central line-associated bloodstream infections (CLABSIs) impact patient outcomes and increase cost of hospitalization. In situ thrombus is known to promote microbial adhesion and colonization and potentially lead to CLABSI. Clinical validation of this theory, adjusting for presence of systemic hypercoagulability, is needed. This study is a retrospective review of all adult and pediatric patients with peripherally inserted central catheter placement over a 4-year period at our tertiary care center. Tissue plasminogen activator (TPA) use was utilized as indicator for line site thrombus. CLABSIs rates were compared in patients with or without TPA use, adjusting for the presence of hypercoagulable conditions, age, and severity of illness. A total of 3,723 patients with peripherally inserted central catheter lines was evaluated, 40% of whom received TPA. The adjusted odds of developing a CLABSI was 3.59 times greater in those patients who received TPA compared with those who did not (95% confidence interval [CI]: 1.86-6.94). Neither severity of illness (odds ratio [OR], 1.00; 95% CI: 0.51-1.96) nor primary (OR, 3.41; 95% CI: 0.43-26.7) or secondary hypercoagulability (OR, 0.91; 95% CI: 0.44-1.88) were statistically associated with a higher risk of infection. The use of TPA, as a possible indicator in situ thrombus, was associated with a higher risk of developing CLABSI. Neither primary nor secondary hypercoagulability was correlated with risk of developing CLABSI.