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Prevention of Coagulase-Negative Staphylococcal Central Venous Catheter–Related Infection Using Urokinase Rinses: A Randomized Double-Blind Controlled Trial in Patients With Hematologic Malignancies

Cornelis J. van Rooden, Emile F. Schippers, Henri F.L. Guiot, Renée M. Barge, Marcel M.C. Hovens, Felix J.M. van der Meer, Frits R. Rosendaal, Menno V. Huisman

From the Departments of General Internal Medicine/Endocrinology, Infectious Diseases, Haematology, and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

Corresponding author: Menno V. Huisman, MD, PhD, Department of General Internal Medicine/Endocrinology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: M.V.Huisman{at}LUMC.nl

Purpose Fibrin deposition at the intraluminal surface of the indwelling part of the central venous catheter (CVC) surface increases the risk of CVC-related coagulase-negative staphylococci (CoNS) infection. Therefore, repetitive enzymatic dissolution of fibrin by urokinase might reduce the risk of CVC-related infection. We undertook this study to investigate whether three times weekly urokinase rinsing of CVC reduces the incidence or severity of CVC-related infections by CoNS in patients undergoing intensive cytotoxic treatment for hematologic malignancies.

Patients and Methods In a double-blind setting, all consecutive patients with a CVC were randomly allocated to receive either urokinase rinses (5 mL of 5,000 U/mL) or placebo (saline), both three times weekly.

Results The percentage of patients with at least one positive culture with CoNS was lower in patients receiving urokinase compared with patients receiving placebo (26% v 42%, respectively; relative risk [RR] = 0.61; 95% CI, 0.39 to 0.94). Major CVC-related CoNS infection occurred less frequently in patients receiving urokinase versus placebo (1.2% v 14.1%, respectively; RR = 0.09; 95% CI, 0.01 to 0.50). Secondary complications, including CVC-related thrombosis, were observed less frequently in the urokinase group compared with the placebo group (1.3% v 9.0%, respectively; RR = 0.14; 95% CI, 0.02 to 0.82). No severe bleeding complications attributable to urokinase were observed.

Conclusion Three times weekly urokinase rinsing reduces the incidence of CVC-related CoNS infection in patients treated with intensive cytotoxic therapy for hematologic malignancies, with acceptable safety.

Supported by Grant No. 99.146 from the Netherlands Heart Foundation (C.J.v.R.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Correspondence

• Are Urokinase Rinses Needed to Reduce Catheter-Related Bloodstream Infections When Standard Preventive Guidelines Are Observed?
  François Blot, Bertrand Gachot, and Gérard Nitenberg
  JCO 2008 26: 2415-2416 [Full Text]

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