A Randomized Trial Comparing Gentamicin/Citrate and Heparin Locks for Central Venous Catheters in Maintenance Hemodialysis Patients

Moran, John A.; Sun, Sumi; Khababa, Ishrag; Pedan, Alex; Doss, Sheila; Schiller, Brigitte

doi:10.1053/j.ajkd.2011.08.031

Cited by 77 publications

(88 citation statements)

References 22 publications

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“…However, a randomized trial of patients with indwelling central venous catheters and hematologic malignancies also observed a 39% lower risk of catheter-related coagulase-negative staphylococci infections. 16 Among hemodialysis patients, a recent randomized trial comparing gentamicin/citrate and heparin locking solutions reported a significant decrease in the risk of catheter-related bacteremia for gentamicin/citrate locking solutions, 17 consistent with earlier related studies. 18 However, the potential side effects of antibiotic locking solutions have reduced their routine use in clinical practice.…”

Section: Discussionsupporting

confidence: 81%

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Manns

Scott-Douglas²,

Ravani

et al. 2014

Journal of the American Society of Nephrology

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In a recent randomized trial, weekly recombinant tissue plasminogen activator (rt-PA), 1 mg per lumen, once per week, and twice-weekly heparin as a locking solution (rt-PA/heparin) resulted in lower risks of hemodialysis catheter malfunction and catheter-related bacteremia compared with thrice-weekly heparin (heparin alone). We collected detailed costs within this trial to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the 6-month trial. Nonparametric bootstrap estimates were used to derive 95% confidence intervals (CIs) and mean cost differences between the treatment groups. The cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. Overall, the difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was Can$323 (95% CI, 2$935 to $1581; P=0.62). When the costs were extrapolated over a 1-year time horizon using decision analysis, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. This finding was sensitive to plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term. In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin. Cost savings due to a lower risk of hospitalization for catheter-related bacteremia partially offset the increased cost of rt-PA.

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Section: Discussionsupporting

confidence: 81%

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Manns

Scott-Douglas²,

Ravani

et al. 2014

Journal of the American Society of Nephrology

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“…The authors suggest that either the low dose of gentamicin used in their study or the avoidance of heparinwhich is known to increase the production of biofilm-may have played a role in the decrease in gentamicin resistance. Moreover, another prospective, randomized controlled study of low-dose gentamicin (0.32 mg/ml) and citrate lock likewise found no significant change in gentamicin resistance during a 5-year period or in the ensuing 3 years when the lock solution was universally implemented (19).…”

mentioning

confidence: 96%

“…Because more recent studies using bundled care without antimicrobial locks have achieved CRBSI rates of #1 per 1000 catheter-days, can the use of antimicrobial locks further reduce CRBSI? Abbas et al performed an observational study of gentamicin-heparin versus heparin catheter locks, while Maki and Moran and their colleagues performed randomized controlled trials with gentamicin-trisodium citrate (citrate) and citratemethylene blue-methylparaben-propylparaben, respectively (17)(18)(19). All three studies achieved CRBSI rates of ,1 per 1000 catheter-days in their control groups and yet still showed a significant decrease in infection rates with their interventions (Abbas, Moran, and Maki et al reported rates of 0.62, 0.28, and 0.24 events per 1000 catheter-days, respectively).…”

mentioning

confidence: 99%

Reducing Catheter-Related Infections in Hemodialysis Patients

Landry

Braden

2014

Clinical Journal of the American Society of Nephrology

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“…5,6 This is supported by the fact that CRBSI rates were <1 per 1000 catheter-days in previous studies. 5,7 Here we attempted to see at any advantage of blood culture from exit site, catheter hub, catheter tip culture versus peripheral vein blood culture.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis catheter related blood stream infections

Subramanyam¹,

Vakrani²

2018

Int J Res Med Sci

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Background: Hemodialysis catheter related blood stream infection (CRBSI) is common cause for sepsis in hemodialysis patients with high morbidity and mortality. It has to be diagnosed promptly for early treatment to avoid serious complications including catheter removal. This prospective study was undertaken to study clinical features, to validate use of cultures drawn from different sites for diagnosis and management of hemodialysis catheter related blood stream infection (CRBSI). As there is paucity of data regarding CRBSI, hence the study was undertaken.Methods: All hemodialysis patients with CRBSI between October 2016 to October 2017 were included. Variables like different catheter position, blood cultures collected from peripheral vein, both catheter hubs, catheter exit site swab, and catheter tip cultures were analyzed with respect to time to culture positivity, microbes and its management were analyzed.Results: Mean duration of hemodialysis catheter inside patient was 24days, most common risk factor for CRBSI was diabetes mellitus (58%) followed by surgery (50%), previous dialysis catheterization within preceding 2months (33%). 30% patients had history of guide wire exchange of catheters previously, most had temporary catheter (88%), most common site of catheter was right internal jugular vein (58%). Cultures showed gram positive organisms in 63%. It was found that same monomicrobial growth was noted in most cultures stating less chances of contamination. Exit site, catheter tip samples and blood sample from catheter’s venous hub yielded early result. It was found that same monomicrobial growth was noted in most cultures stating less chances of contamination. Among complications, 8% had endocarditis, 61% had catheter removal. Average hospital stay was 9days. Deferve scence was noted upon antibiotic therapy and catheter removal in most cases. Death was noted in 8% due to sepsis.Conclusions: CRBSI are major cause of admissions, morbidity and mortality in hemodialysis patients on catheters. Gram positive organisms were commonest pathogens causing CRBSI. Exit site, catheter tip samples and blood sample from catheter’s venous hub yielded early result. Peripheral blood sampling for culture diagnosing was unnecessary. Most requires 2-6weeks systemic antibiotics and catheter removal especially if persistent fever and systemic complications are present.

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A Randomized Trial Comparing Gentamicin/Citrate and Heparin Locks for Central Venous Catheters in Maintenance Hemodialysis Patients

Cited by 77 publications

References 22 publications

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Reducing Catheter-Related Infections in Hemodialysis Patients

Hemodialysis catheter related blood stream infections

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