Antibiotic‐Lock Technique: A New Approach to Optimal Therapy for Catheter‐Related Sepsis in Home‐Parenteral Nutrition Patients

Messing, Bernard; Peitra-Cohen, Sophie; Debure, A.; Beliah, M.; Bernier, J J

doi:10.1177/0148607188012002185

Cited by 264 publications

(140 citation statements)

References 17 publications

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“…56 Antimicrobial (taurolidine) flush solutions and antibiotic lock techniques have been proposed for patients with recurrent CVC infections. 57,58 A recent randomised study of 30 patients found taurolidine lock to be highly effective in reducing subsequent CVC infection with a mean infection-free survival of 175 days compared with 641 days with the introduction of taurolidine locks (P ! 0.0001).…”

Section: Complications Of Long-term Pnmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

137

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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Section: Complications Of Long-term Pnmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

137

108

View full text Add to dashboard Cite

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“…More than 20 years ago, a new method for treating CRB in patients who received total parenteral nutrition [37] was first reported. This technique involves instilling a highly concentrated antimicrobial−anticoagulant solution at the end of a dialysis session which "locks" the catheter when it is not in use [38].…”

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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“…Several open trials of antibiotic lock therapy of tunneled catheter-related bacteremia, with or without concomitant parenteral therapy, have reported a response and catheter salvage without relapse in 138 (82.6%) of 167 episodes (Messing et al 1988;Capdevila et al 1993;Johnson et al 1994;Williams et al 1994;Benoit et al 1995;Krzywda et al 1995;Mermel et al 2001). Compared with parenteral therapy used in the aforementioned open trials, therapy including AL was significantly more likely to result in catheter salvage.…”

Section: Discussionmentioning

confidence: 99%

Elimination of Intraluminal Colonization by Antibiotic Lock in Catheters

Öncü

Öztürk

et al. 2004

Tohoku J. Exp. Med.

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Antibiotic lock (AL) technique for catheter related infection encompasses the filling of a catheter lumen with high concentrations of antibiotics for hours. The goal of AL therapy is to decontaminate the intraluminal surface of the catheter. However the duration of antibiotic therapy is not established. An in vitro model was designed to establish the time needed to eliminate intraluminal microbial colonization and to evaluate the efficacy of vancomycin in comparison with teicoplanin by using laboratory AL model. Human plasma was instilled into the catheters to allow deposition of fibrin and other products on the catheter wall. After 48 hours, the catheters were drained and inoculated with bacteria in tryptic soy broth. The catheters were then drained and filled with either (a) vancomycin saline solution (VSS) lock (b) teicoplanin saline solution (TSS) lock or (c) saline solution (SS) as the control and then incubated for 12 hours. After 12 hours incubation all the catheter were drained and filled with human plasma. Instillation of human plasma and AL was alternated every 12 hours to simulate clinical conditions. For each day three catheters, locked with VSS, TSS and SS were cultured for colony count. Microbial counts were expressed as total colony-forming units per longitudinal centimeters of catheter surface. A significant decrease in intraluminal catheter colonization started as early as day 1. At the end of 7th day catheters treated with VSS and TSS lock were completely sterile. The decrease of intraluminal colonization was similar in catheters treated with VSS and TSS lock. Also the decrease of intraluminal colonization were similar in catheter colonized with slime forming S. epidermidis and nonslime-forming S. epidermidis. antibiotic lock; catheter; teicoplanin; vancomycin

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Antibiotic‐Lock Technique: A New Approach to Optimal Therapy for Catheter‐Related Sepsis in Home‐Parenteral Nutrition Patients

Cited by 264 publications

References 17 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

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

Elimination of Intraluminal Colonization by Antibiotic Lock in Catheters

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