Elimination of Intraluminal Colonization by Antibiotic Lock in Catheters

Abstract

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

In vitro effectiveness of antifungal lock solutions on catheters infected with Candida species

“…Presently, at least 2 weeks of AL treatment is recommended for intraluminal catheter infection caused by virulent microorganisms. On the other hand, studies conducted by Oncu et al [6,24] displayed the efficiency of shorter AL therapy in catheters infected by staphylococci. However, studies investigating the optimal duration of antifungal lock therapy are missing in the literature.…”

“…In current guidelines, CVC removal is considered as an integral part of the therapeutic approach to CRI caused by fungi [3]. However, removal of a CVC, particularly a tunneled CVC used for long-term catheterization in a critically ill patient, is associated with significant practical problems and cost [5,6]. It is assumed that a conservative treatment strategy of the catheter in CRI could be adopted in clinically stable patients to avoid intravascular catheter replacement.…”

The Effect of Systemic Vancomycin on Central Venous Catheter Colonization

“…CRIs are associated with increased mortality, morbidity, length of hospital stay and medical cost (2,11). Infection rates vary greatly, depending on the type of device, and are highest with CVCs of all types (5) The catheter should also be removed as soon as practicable, as one of the most effective and cost -efficient way of reducing the incidence of CRI.…”

Controversies on Antibiotic Lock Technique Duration Experience with a 3-Day Course for Hematological Patients

“…3,4 Data on the emergence of carbapenem-resistant (CR) GNB in gastrointestinal flora and the selective capacity of carbapenem exposure are limited. We conducted a feasibility trial to evaluate the gastrointestinal selective capacity of 3 carbapenems for CR Acinetobacter baumannii, CR Pseudomonas aeruginosa, and CR Stenotrophomonas maltophilia among patients treated for healthcareassociated pneumonia.…”

“…Moreover, the duration of the ALT is controversial, and in vitro studies have demonstrated that shorter periods may be sufficient. 4 Also, the recent article by Sauer et al 8 suggests that a shorter ALT may be as effective as a longer-duration technique.…”