Urokinase in the treatment of bacteremia and candidemia in patients with right atrial catheters

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.