Intraluminal Antibiotic Treatment of Central Venous Catheter Infections in Patients Receiving Parenteral Nutrition at Home

Abstract

We carried out an open, uncontrolled, prospective study to evaluate intraluminal antibiotic therapy for bloodstream infections arising from subcutaneously tunneled central venous catheters in patients receiving parenteral nutrition therapy at home. Seven bacterial infections were treated with intraluminal antibiotics (mean duration, 8.6 days) sometimes accompanied by systemic antibiotics (mean duration, 2.1 days). All seven infections were cured. Two infections caused by Candida species were treated with intraluminal amphotericin B. Fungal infections was suppressed during treatment but later relapsed, as confirmed by pulsed field DNA electrophoresis typing of bloodstream isolates. The concentration of antibiotic was assayed in intraluminal fluid from catheters of patients receiving treatment with vancomycin or gentamicin. The concentration was initially approximately 5 mg/mL, and it remained at > or = 2.5 mg/mL throughout the period that the solution was locked in the catheter. Our findings show that intraluminal therapy is effective against selected bacterial infections and can suppress fungal infections in subcutaneously tunneled catheters.

Elimination of Intraluminal Colonization by Antibiotic Lock in Catheters

“…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.…”

“…No significant differences in growth reduction were observed between the vancomycin and teicoplanin containing antibioticsaline locks. There are many studies in which vancomycin was evaluated for the AL technique (Gaillard et al 1990;Benoit et al 1995;Andris et al 1998;Carratala et al 1999;Haimi-Cohen et al 2001;Vercaigne et al 2002). But studies with teicoplanin are limited.…”

First Case of Septicemia Due to a Strain Belonging to Enteric Group 58 ( Enterobacteriaceae ) and Its Designation as Averyella dalhousiensis gen. nov., sp. nov., Based on Analysis of Strains from 20 Additional Cases

“…The port site was not erythematous or tender, and the remainder of the physical exam was unremarkable. The leukocyte count was 8.0 ϫ 10 3 / mm 3 , with 38% band forms. An initial clinical chemistry profile and a chest radiograph were normal.…”

Catheter-related bloodstream infections: catheter management according to pathogen

“…Echocardiography should be carried out in at-risk patients to diagnose possible endocarditis, which requires therapy for 4-6 weeks [56,57]. Patients who are being considered for a shorter duration of therapy should also have transoesophageal echocardiography, which is most sensitive when performed 5-7 days after the onset of bacteraemia [58].…”

“…Compared with bacterial infection, Candida CRBSI is more difficult to eradicate with antibiotic lock therapy [74][75][76]. Echinocandins, lipid formulations of amphotericin B and ethanol-based lock solutions have been studied, and seem to be effective in vitro, but further clinical studies are required in the setting of catheter-related candidaemia.…”