Adjunctive Antibiotic/Anticoagulant Lock Therapy in the Treatment of Bacteremia Associated with the Use of a Subcutaneously Implanted Hemodialysis Access Device

Abstract

To improve vascular access for hemodialysis, a new device (Dialock Hemodialysis Access System, Biolink Corporation, Middleboro, MA) has been developed. Implanted subcutaneously, the device is accessed by percutaneous puncture. Attached to the device are two catheters that are implanted into the superior vena cava or right atrium. Clinical results thus far have been promising. However, use of this device is not free from infectious complications. In the present pilot study, 25 maintenance hemodialysis patients were implanted with 26 Dialock devices. The incidence of bacteremia was 2.9/1,000 catheter days. In 14 episodes of bacteremia in 8 patients the infection was successfully treated with a combination of systemic antibiotic treatment and adjunctive antibiotic/anticoagulant lock therapy. The lock therapy entailed the instillation of both an antibiotic and an anticoagulant into the device. We believe that the antibiotic/anticoagulant lock technique is an effective, adjunctive therapeutic modality in the treatment of infections related to the use of indwelling vascular access devices.

Optimal Antimicrobial Catheter Lock Solution, Using Different Combinations of Minocycline, EDTA, and 25-Percent Ethanol, Rapidly Eradicates Organisms Embedded in Biofilm

“…Through two independent models of biofilm colonization, we showed that M-EDTA in 25% ethanol completely eradi- (2,4,6,9,14,24,25,32,38). Vancomycin in combination with heparin has been the most commonly used ALT combination (1, 2, 4, 6, 13, 18, 19, 21).…”

Current Management of Vascular Access

“…The goal of an antibiotic lock is to sterilize the catheter biofilm while salvaging the catheter. A number of studies that were performed in tunneled dialysis catheters (133,137,154 -156), as well as those used for chemotherapy or total parenteral nutrition (155,(157)(158)(159)(160), have documented an approximately 70% clinical cure rate in patients who were treated with systemic antibiotics in conjunction with an antibiotic lock. No randomized studies have compared the antibiotic lock approach with routine catheter replacement in patients with dialysis catheter-related bacteremia.…”

Implantation of a New Access Device for Hemodialysis (Dialock): Initial Experience in 5 Patients

“…Related to the number of implant days this was equal to 2.5 bacteremias per 1000 patient days, comparing favorably with that of standard permanent catheters (up to 5.1) [8]. According to this and another study [9], the successful therapy consisted of a catheter lock of heparin and antibiotics between the dialysis sessions, combined with systemic antibiotic therapy. In none of the cases was there a need to remove the device.…”