Comparison of Early versus Late Use of Antibiotic Locks in the Treatment of Catheter-Related Bacteremia

Onder, Ali Mirza; Chandar, Jayanthi; Billings, Anthony A.; Simon, Nancy; Díaz, Rosa; Francoeur, Diane; Abitbol, Carolyn; Zilleruelo, Gastón

doi:10.2215/cjn.04931107

Cited by 24 publications

(28 citation statements)

References 28 publications

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“…Forty-four were excluded for having no control arm, and three studies [6,7,8] were excluded for a comparison arm of routine catheter exchange. Eight relevant studies meeting inclusion criteria were identified and are listed in table 1[9,10,11,12,13,14,15,16]. …”

Section: Resultsmentioning

confidence: 99%

“…Four studies were prospective interventions [12,15], with one randomized controlled trial and two historically controlled prospective trials of ALT [9,13]. Four were retrospective chart review studies [10,11,12,13,16].…”

Section: Resultsmentioning

confidence: 99%

“…Lock solutions used in studies were highly variable, using 74% ethanol [10], third-generation cephalosporins [11,13], aminoglycosides [11,12], ciprofloxacin [11,12] and imipenem-based solutions [12]. Most studies used ALT in conjunction with systemic therapy, with oral antibiotics in one study [9] and IV antibiotics in five [10,11,16,17].…”

Section: Resultsmentioning

confidence: 99%

“…Comparison treatments were somewhat less varied with most trials using either IDSA-recommended systemic antibiotic regimens [10,12,15] or wire-guided exchange [13,14] as controls. Three studies [9,11,16] used systemic antibiotic therapies, which were not defined by IDSA.…”

Section: Resultsmentioning

confidence: 99%

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Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

2011

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Central line-associated bloodstream infections (CLABSI) are associated with considerable morbidity, mortality and economic costs. In most cases, catheter removal is considered an essential component of managing CLABSI. However, in patients with poor access, catheter salvage may have to be attempted rather than removal and replacement of catheters. Anti-infective lock therapy (ALT) – instilling an antibiotic or antiseptic into the catheter lumen – is a novel way of treating CLABSI while attempting to salvage the catheter. However, data on the efficacy of ALT for catheter salvage is limited. In this systematic review, we critically review the evidence regarding the use of ALT for catheter salvage. We identified 8 studies including a total of 396 patients that compared ALT with systemic antibiotic therapy alone or an alternate method of catheter salvage (guidewire replacement). We found that the combination of systemic antibiotics and culture-guided lock therapy was superior to systemic antibiotics alone (OR: 0.20, 95% CI: 0.10–0.39), with 10% of locked patients requiring replacement compared to 33% of subjects without locks. There was a 20% relapse rate in the ALT group and a 30% relapse rate in the control group (OR: 0.43, 95% CI: 0.18–1.03). There was insufficient data on catheter exchange over a wire compared with ALT to permit conclusions. Our data support the use of ALT in conjunction with systemic antibiotics for catheter salvage. Large randomized controlled trials of ALT examining dose, dwell times and relapse rates stratified by infecting pathogen are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

2011

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“…In a recent study by Onder et al, it was reported that AMLs are significantly more effective in clearing CRB in children on HD when used early in infection, diminishing the need for catheter exchange [44]. An AML with tissue plasminogen activator (TPA, 1 mg/ ml), tobramycin (5 mg/ml), and vancomycin (5 mg/ml) was used for 2 weeks following the initial empiric treatment of CRB in children on HD.…”

Section: Time For Preventing Recurrence Of Catheter-related Bacteremiamentioning

confidence: 99%

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Stefanidis

2009

Pediatr Nephrol

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This editorial commentary discusses the strategies for prevention of catheter-related bacteremia (CRB) in children on hemodialysis, which is associated with high morbidity and the increase of hospital cost. There is evidence that the use of arteriovenous fistulae in children on hemodialysis is associated with lower infection rates. Therefore, the use of catheters in these patients should be decreased by improving arteriovenous fistulae use rates or by increasing peritoneal dialysis patient recruitment. However, despite the wide adoption of such policies, hemodialysis catheters are still being used in a significant number of cases. For these patients, implementation of effective strategies for preventing contamination of the catheter hub should be a priority. The appropriate recording and evaluation of CRB rates are important for assessing preventive policies. In addition, the successful management of a CRB is essential for preventing recurrence of bacteremia. Recently it was documented in a number of randomized clinical trials that antimicrobial lock solutions were effective for preventing CRB. It is suggested that the use of antimicrobial locks should be considered in children who are at high risk of developing CRB, with caution for their long-term use, because of the possibility of bacterial resistance. Now is the time for action, and all preventive steps should be performed simultaneously to minimize the risk of CRB.

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No evidence of benefit from antibiotic lock therapy in pediatric oncology patients with central line-related bloodstream infection: Results of a retrospective matched cohort study and review of the literature

Wolf

Allison

et al. 2014

Pediatr Blood Cancer

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Comparison of Early versus Late Use of Antibiotic Locks in the Treatment of Catheter-Related Bacteremia

Cited by 24 publications

References 28 publications

Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

No evidence of benefit from antibiotic lock therapy in pediatric oncology patients with central line-related bloodstream infection: Results of a retrospective matched cohort study and review of the literature

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