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Thromb Haemost 2022; 122(07): 1198-1208
DOI: 10.1055/a-1695-8612
Stroke, Systemic or Venous Thromboembolism

Transient Bacteremia Promotes Catheter-Related Central Venous Thrombosis through Neutrophil Extracellular Traps

Jeng-Wei Chen
1   Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
2   Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
,
Chih-Chieh Hsu
3   Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
4   Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
,
Chien-Chia Su
2   Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
5   Department of ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
,
Ron-Bin Hsu
1   Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
,
Yen-Ling Chiu
2   Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
6   Division of Nephrology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
7   Graduate Program in Biomedical Informatics, Department of Computer Science and Engineering, College of Informatics, Yuan Ze University, Taoyuan, Taiwan
,
Chiau-Jing Jung    *
8   Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
,
Jean-San Chia   *
2   Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
4   Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
9   Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, Taiwan
› Author Affiliations Funding This study was supported by the Ministry of Science and Technology of Taiwan (MOST 108–2314-B-002–088-MY3, MOST 108–2320-B-038–057-MY3, and MOST 110–2320-B-002-064).
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Abstract

Formation of intravenous catheter-related thrombosis leads to central venous stenosis in patients requiring renal replacement therapy or chemotherapy infusion, yet the triggers or mechanisms remain unclear, especially in patients without symptoms of infection. In this study, we found that neutrophil extracellular traps (NETs) could be detected in the fibrin sheaths from dialysis patients without clinical manifestations of infection. Confocal microscopy revealed bacteria imbedded in NETs in the fibrin sheaths. Thirty-nine of 50 (78%) fibrin sheath specimens contained bacteria detectable by 16S ribosomal RNA genome typing with a predominance of Staphylococcus aureus (69%). In rat models, transient bacteremia of S. aureus induced NETs in enlarged fibrin sheaths, and treatment with DNase I alone significantly reduced both NET and fibrin sheath formation surrounding the catheter. Therefore, transient bacteremia could be a silent trigger that induces NET-related immunothrombosis enhancing catheter-related central venous stenosis.

Keywords

transient bacteremia - neutrophil extracellular traps - Staphylococcus aureus - catheter-related central venous thrombosis

* Chiau-Jing Jung and Jean-San Chia contributed equally to this work.


Supplementary Material



Publication History

Received: 25 May 2021

Accepted: 10 November 2021

Accepted Manuscript online:
12 November 2021

Article published online:
21 January 2022

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