Prolonged bacteremia with catheter-related central venous thrombosis
D. G. Rupar, K. D. Herzog, M. C. Fisher and S. S. Long
Section of Infectious Diseases, St Christopher's Hospital for Children, Philadelphia, Pa.
Infection of a central venous thrombus is a serious but rarely recognized
complication of the use of central venous catheters in children. We report
the cases of seven children with persistent bacteremia or fungemia in which
central venous thrombosis was demonstrated by ultrasonography after removal
of the catheter. All patients had signs and symptoms of infection, but only
one had clinical evidence of central venous stasis. Bacteremia persisted
from 6 to 35 days. Infection did not resolve in any patient prior to
catheter removal, and five patients had positive blood cultures for 5 or
more days after removal of the catheter. Six patients, including all who
survived, were treated parenterally with antibiotics for more than 28 days.
Two patients died; neither death was directly attributable to infection.
Central venous thrombosis should be suspected in patients with persistent
catheter-related bacteremia. Optimal treatment of this problem is not yet
known.
