Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution

Krishnasami, Zipporah; Carlton, Donna; Bimbo, Lisa; Taylor, Maria E.; Balkovetz, Daniel F.; Barker, Jill; Allon, Michael

doi:10.1046/j.1523-1755.2002.00201.x

Cited by 254 publications

(192 citation statements)

References 24 publications

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“…However, probable catheter-related bacteremia was diagnosed in only 60% of cases with suspected infection, emphasizing the importance of considering other sources of infections in catheter-dependent patients. This finding is in agreement with three prior studies that reported a 59% to 81% likelihood of bacteremia in catheterdependent patients with suspected infection (12)(13)(14). The other infections included secondary-access (fistula, graft, or peritoneal dialysis catheter) infection and nonaccessrelated infection.…”

Section: Discussionsupporting

confidence: 92%

The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients

Al-Solaiman¹,

Estrada²,

Allon³

2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Catheter-dependent hemodialysis patients may develop access-related and nonaccess-related infections that may be managed in the outpatient arena or in the hospital. The goal of this study was to quantify infections in such patients, to characterize their clinical presentations, and to evaluate factors determining need for hospitalization.Design, setting, participants, & measurements We collected prospective data on the clinical management of catheter-dependent hemodialysis patients with suspected infection at a large dialysis center. We documented the presenting symptoms, type of infection, pathogen, and whether hospitalization occurred.Results An infection was suspected in 305 separate cases and confirmed in 88%. The 268 diagnosed infections included catheter-related bacteremia (69%), another access-related infection (19%), and nonaccess-related infection (12%). The overall frequency of infection was 4.62 per 1000 catheter-days. Hospitalization occurred in 37% of all infections, but it varied greatly (72% for nonaccess-related infection, 34% for catheterrelated bacteremia, and 4% for exit-site infection). Among patients with catheter-related bacteremia, the likelihood of hospitalization varied by pathogen, being 53% for Staphylococcus aureus, 30% for Enterococcus, 23% for Staphylococcus epidermidis, and 17% for gram-negative rods (P Ͻ 0.001). The likelihood of hospitalization was not associated with age, gender, or diabetes. Fever was a presenting symptom in only 47% of cases of catheter-related bacteremia.Conclusions Catheter-dependent patients have a high burden of infection. It is important to evaluate patients with suspected infection for various access-related and nonaccess-related infections. A low threshold is indicated for suspecting catheter-related bacteremia because the patients frequently present without fever.

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Section: Discussionsupporting

confidence: 92%

The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients

Al-Solaiman¹,

Estrada²,

Allon³

2011

Clinical Journal of the American Society of Nephrology

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“…None of the patients of these study required catheter removal to cure the CRB [39]. In two subsequent studies, with a vancomycin-gentamicin-heparin lock, 35% and 38% of patients, respectively, failed AML therapy and required catheter exchange [40,41]. In a more recent prospective study, similar results were reported when gentamicin was replaced at the AML solutions with ceftazidime because of reported episodes of gentamicininduced ototoxicity.…”

Section: Time For Preventing Recurrence Of Catheter-related Bacteremiamentioning

confidence: 74%

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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“…Empiric antibiotics were initiated after blood cultures were obtained. Patients received a 3-week course of systemic antibiotics, in conjunction with an antibiotic-heparin lock instilled into the catheter lumen (12,13). The dialysis catheter was replaced in patients with persistent symptoms despite appropriate antibiotics or in patients with recurrent bacteremia.…”

Section: Management Of Catheter Malfunction and Infectionmentioning

confidence: 99%

Does the Heparin Lock Concentration Affect Hemodialysis Catheter Patency?

Ivan

Smith

Allon

2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Concentrated heparin solutions are instilled into the catheter lumens after each hemodialysis session to prevent catheter thrombosis. The heparin lock concentration at many centers has been decreased recently to reduce the risk of systemic bleeding and contain costs. However, the effect of this change on catheter patency is unknown. We compared catheter patency between two heparin lock solutions: 1000 versus 5000 units/ml. Design, setting, participants, & measurements: With use of a prospective, computerized, vascular access database, 105 patients with newly placed tunneled hemodialysis catheters, including 58 patients receiving a 5000 units/ml heparin lock and 47 patients receiving a 1000 units/ml heparin lock, were retrospectively identified. The primary endpoint was cumulative catheter patency and the secondary endpoint was frequency of thrombolytic instillation.Results: Cumulative catheter survival was similar in the two groups, being 71% versus 73% at 120 days in the low-and high-concentration heparin lock groups (hazard ratio of catheter failure, 0.97; 95% confidence interval, 0.45 to 2.09; P ‫؍‬ 0.95). The frequency of tissue plasminogen activator instillation was significantly greater in the low-concentration heparin group (hazard ratio, 2.18; 95% CI, 1.26 to 3.86; P ‫؍‬ 0.005). No major bleeding complications were observed in either treatment group. The overall drug cost for maintaining catheter patency was 23% lower with the low-concentration heparin lock ($1418 versus $1917) to maintain catheter patency for 1000 days.Conclusions: Low-concentration heparin lock solutions do not decrease cumulative dialysis catheter patency, but require a twofold increase in thrombolytic instillation to maintain long-term patency.

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Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution

Abstract: Use of an antibiotic lock, in conjunction with systemic antibiotic therapy, can eradicate catheter-associated bacteremia while salvaging the catheter in about one half of cases. Moreover, this management approach offers clinical advantages over routine catheter exchange.

Cited by 254 publications

References 24 publications

The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients

The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients

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

Does the Heparin Lock Concentration Affect Hemodialysis Catheter Patency?

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