Antibiotic lock therapy: review of technique and logistical challenges

Justo, Julie Ann; Bookstaver, P. Brandon

doi:10.2147/idr.s51388

Cited by 53 publications

(43 citation statements)

References 115 publications

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“…Among the numerous approaches used to prevent intraluminal contamination of catheters is the so-called lock therapy (Sousa et al 2011;Justo & Bookstaver 2014). This consists in closing the catheter and exposing its internal surface to 1-2 ml of a solution containing a highly concentrated antibiotic (up to 1,000 times the MIC) in order to eradicate the biofilm and an anticoagulant to prevent thrombosis (Sousa et al 2011;Justo & Bookstaver 2014). After 12-24 h, the lock solution is removed, but repetition of the treatment at 24 h intervals for up to 15-days might be needed for complete eradication.…”

Section: Discussionmentioning

confidence: 99%

“…After 12-24 h, the lock solution is removed, but repetition of the treatment at 24 h intervals for up to 15-days might be needed for complete eradication. Although clinical guidelines recommend the lock therapy in non-complicated cases of long-term catheter stay, the actual lock therapies have several limits regarding both the antimicrobial and the anticoagulant agents (Mermel et al 2009;Justo & Bookstaver 2014). Among the major limits, there is the need to use high concentrations of antibiotics that may cause systemic toxicity and/or promote the selection and diffusion of multidrug resistant strains.…”

Section: Discussionmentioning

confidence: 99%

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Anti-biofilm properties of the antimicrobial peptide temporin 1Tb and its ability, in combination with EDTA, to eradicate Staphylococcus epidermidis biofilms on silicone catheters

et al. 2016

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In search of new antimicrobials with anti-biofilm potential, in the present study activity of the frog-skin derived antimicrobial peptide temporin 1Tb (TB) against Staphylococcus epidermidis biofilms was investigated. A striking ability of TB to kill both forming and mature S. epidermidis biofilms was observed, especially when the peptide was combined with cysteine or EDTA, respectively. Kinetics studies demonstrated that the combination TB/EDTA was active against mature biofilms already after 2-4-h exposure. A double 4-h exposure of biofilms to TB/EDTA further increased the therapeutic potential of the same combination. Of note, TB/EDTA was able to eradicate S. epidermidis biofilms formed in vitro on silicone catheters. At eradicating concentrations, TB/EDTA did not cause hemolysis of human erythrocytes. The results shed light on the anti-biofilm properties of TB and suggest a possible application of the peptide in the lock therapy of catheters infected with S. epidermidis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anti-biofilm properties of the antimicrobial peptide temporin 1Tb and its ability, in combination with EDTA, to eradicate Staphylococcus epidermidis biofilms on silicone catheters

et al. 2016

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“…During ALT, supratherapeutic concentrations of antibiotic solutions are locked in the affected catheter for an extended amount of time [13, 14]. However, to our knowledge, the effect of ALT on S. marcescens biofilms has not yet been studied extensively in vivo nor in vitro.…”

Section: Introductionmentioning

confidence: 99%

Killing of Serratia marcescens biofilms with chloramphenicol

Ray

Shenoy

Orihuela

2017

Ann Clin Microbiol Antimicrob

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Serratia marcescens is a Gram-negative bacterium with proven resistance to multiple antibiotics and causative of catheter-associated infections. Bacterial colonization of catheters mainly involves the formation of biofilm. The objectives of this study were to explore the susceptibility of S. marcescens biofilms to high doses of common antibiotics and non-antimicrobial agents. Biofilms formed by a clinical isolate of S. marcescens were treated with ceftriaxone, kanamycin, gentamicin, and chloramphenicol at doses corresponding to 10, 100 and 1000 times their planktonic minimum inhibitory concentration. In addition, biofilms were also treated with chemical compounds such as polysorbate-80 and ursolic acid. S. marcescens demonstrated susceptibility to ceftriaxone, kanamycin, gentamicin, and chloramphenicol in its planktonic form, however, only chloramphenicol reduced both biofilm biomass and biofilm viability. Polysorbate-80 and ursolic acid had minimal to no effect on either planktonic and biofilm grown S. marcescens. Our results suggest that supratherapeutic doses of chloramphenicol can be used effectively against established S. marcescens biofilms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12941-017-0192-2) contains supplementary material, which is available to authorized users.

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“…when they are not in use (2). Studies analyzing ALT have reported infection resolution in 42 to 100% of cases, depending on the patient population, the concomitant use of systemic antibiotics, and the microorganism involved (3,4).…”

mentioning

confidence: 99%

Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Freire

Pierrotti

Zerati

et al. 2018

Antimicrob Agents Chemother

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The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.

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Antibiotic lock therapy: review of technique and logistical challenges

Cited by 53 publications

References 115 publications

Anti-biofilm properties of the antimicrobial peptide temporin 1Tb and its ability, in combination with EDTA, to eradicate Staphylococcus epidermidis biofilms on silicone catheters

Anti-biofilm properties of the antimicrobial peptide temporin 1Tb and its ability, in combination with EDTA, to eradicate Staphylococcus epidermidis biofilms on silicone catheters

Killing of Serratia marcescens biofilms with chloramphenicol

Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

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