Antibiotic-lock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition

Messing, Bernard; Man, Fernando; Colimon, R.; Thuillier, F.; Beliah, M.

doi:10.1016/0261-5614(90)90023-l

Cited by 87 publications

(58 citation statements)

References 20 publications

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“…This diagnostic method, which avoids unnecessary catheter removal, could be coupled with early targeted antimicrobial intervention such as antibiotic lock therapy (12,15) and could result in improved patient care in this highly compromised patient population. Although our data do not suggest that prior antimicrobial therapy may lead to misclassification of primary BSI, larger prospective studies are necessary to assess the influence of prior administration of broad-spectrum antibiotics on the diagnostic yield and accuracy of the DTP technique.…”

Section: Discussionmentioning

confidence: 99%

Bloodstream Infection in Neutropenic Cancer Patients Related to Short-Term Nontunnelled Catheters Determined by Quantitative Blood Cultures, Differential Time to Positivity, and Molecular Epidemiological Typing with Pulsed-Field Gel Electrophoresis

et al. 2003

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To determine the rate of catheter-related bloodstream infection (CRBSI) among cases of primary bloodstream infection (BSI) in febrile neutropenic cancer patients with short-term nontunnelled catheters, quantitative paired blood cultures (Isolator) from the central venous catheter (CVC) and peripheral vein were obtained between November 1999 and January 2001. Bactec blood culture bottles were obtained to determine the differential time to positivity (DTP). CRBSI was defined as a quantitative blood culture ratio of >5:1 (CVC versus peripheral) with proven identity of isolates from positive peripheral and CVC blood cultures as confirmed by pulsed-field gel electrophoresis. Forty-nine episodes of primary BSI were detected among 235 cancer patients with febrile neutropenia. Of these, 18 episodes (37%) were CRBSI and 31 (63%) were BSI with an unknown portal of entry. Coagulase-negative staphylococci were present in nine cases of CRBSI (50%). The identity of isolates from peripheral and CVC blood cultures was confirmed in all cases. Earlier positivity (>2 h) of CVC-drawn versus peripheral blood cultures was observed in 18 of 22 CRBSI-associated blood cultures (sensitivity, 82%; specificity, 88%; positive predictive value, 75%; negative predictive value, 92%). In summary, CRBSI accounted for 37% of cases of primary BSI in this population of neutropenic cancer patients. DTP compares favourably with quantitative blood cultures for the diagnosis of CRBSI and may be particularly useful for patients in whom catheter salvage is highly desirable.

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Section: Discussionmentioning

confidence: 99%

Bloodstream Infection in Neutropenic Cancer Patients Related to Short-Term Nontunnelled Catheters Determined by Quantitative Blood Cultures, Differential Time to Positivity, and Molecular Epidemiological Typing with Pulsed-Field Gel Electrophoresis

et al. 2003

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“…While a number of uncontrolled case series exist to support ALT for catheter salvage [17,18,19,20] in the setting of CLABSI, controlled data are scant. The only RCT is by Rijnders et al [15] from 2005 comparing lock with systemic antibiotics to systemic antibiotics alone.…”

Section: Discussionmentioning

confidence: 99%

Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

2011

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Central line-associated bloodstream infections (CLABSI) are associated with considerable morbidity, mortality and economic costs. In most cases, catheter removal is considered an essential component of managing CLABSI. However, in patients with poor access, catheter salvage may have to be attempted rather than removal and replacement of catheters. Anti-infective lock therapy (ALT) – instilling an antibiotic or antiseptic into the catheter lumen – is a novel way of treating CLABSI while attempting to salvage the catheter. However, data on the efficacy of ALT for catheter salvage is limited. In this systematic review, we critically review the evidence regarding the use of ALT for catheter salvage. We identified 8 studies including a total of 396 patients that compared ALT with systemic antibiotic therapy alone or an alternate method of catheter salvage (guidewire replacement). We found that the combination of systemic antibiotics and culture-guided lock therapy was superior to systemic antibiotics alone (OR: 0.20, 95% CI: 0.10–0.39), with 10% of locked patients requiring replacement compared to 33% of subjects without locks. There was a 20% relapse rate in the ALT group and a 30% relapse rate in the control group (OR: 0.43, 95% CI: 0.18–1.03). There was insufficient data on catheter exchange over a wire compared with ALT to permit conclusions. Our data support the use of ALT in conjunction with systemic antibiotics for catheter salvage. Large randomized controlled trials of ALT examining dose, dwell times and relapse rates stratified by infecting pathogen are needed.

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“…57 In small, uncontrolled clinical trials, "antibiotic lock therapy" (ALT), usually in conjunction with systemic antibiotic therapy, "cure" rates of infected IVDs in excess of 90% have been reported. 35,[58][59][60] The vast majority of IVDs reported in these studies were infected with gram-positive organisms other than S. aureus and Bacillus sp.-primarily coagulase-negative staphylococciand gram-negative bacilli other than P. aeruginosa. Data are lacking on the utility of ALT for fungal IVDR BSIs and therefore, at this time, ALT cannot be recommended for the management of long-term IVDs infected by S. aureus, Bacillus sp., Corynebacterium JK, Stenotrophomonas spp., B. cepacia, all pseudomonas species, fungi or mycobacterial species.…”

Section: Diagnostic Studiesmentioning

confidence: 99%

Infections in the Neutropenic Patient— New Views of an Old Problem

Donowitz¹,

Maki²,

Crnich³

et al. 2001

Hematology

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Infection in the neutropenic patient has remained a major clinical challenge for over three decades. While diagnostic and therapeutic interventions have improved greatly during this period, increases in the number of patients with neutropenia, changes in the etiologic agents involved, and growing antibiotic resistance have continued to be problematic.The evolving etiology of infections in this patient population is reviewed by Dr. Donowitz. Presently accepted antibiotic regimens and practices are discussed, along with ongoing controversies.In Section II, Drs. Maki and Crnich discuss linerelated infection, which is a major infectious source in the neutropenic. Defining true line-related bloodstream infection remains a challenge despite the fact that various methods to do so exist. Means of prevention of line related infection, diagnosis, and therapy are reviewed.Fungal infection continues to perplex the infectious disease clinician and hematologist/ oncologist. Diagnosis is difficult, and many fungal infections will lead to increased mortality even with rapid diagnosis and therapy. In Section III, Dr. Pappas reviews the major fungal etiologies of infection in the neutropenic patient and the new anti-fungals that are available to treat them.Finally, Dr. Rolston reviews the possibility of outpatient management of neutropenic fever. Recognizing that neutropenics represent a heterogeneous group of patients, identification of who can be treated as an outpatient and with what antibiotics are discussed.

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Antibiotic-lock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition

Cited by 87 publications

References 20 publications

Bloodstream Infection in Neutropenic Cancer Patients Related to Short-Term Nontunnelled Catheters Determined by Quantitative Blood Cultures, Differential Time to Positivity, and Molecular Epidemiological Typing with Pulsed-Field Gel Electrophoresis

Bloodstream Infection in Neutropenic Cancer Patients Related to Short-Term Nontunnelled Catheters Determined by Quantitative Blood Cultures, Differential Time to Positivity, and Molecular Epidemiological Typing with Pulsed-Field Gel Electrophoresis

Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

Infections in the Neutropenic Patient— New Views of an Old Problem

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