Antimicrobial Locks: Putting the Lock on Catheter Infections

Manierski, C.; Besarab, Anatole

doi:10.1053/j.ackd.2006.04.003

Cited by 34 publications

(16 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is a major concern for the CDC and the primary reason for the lack of a recommendation for the routine use of any prophylactic antibiotic lock, because studies showing efficacy in reducing CRBSI are numerous (11)(12)(13)(14)(15). Most studies evaluating efficacy of antibiotic lock have been of small size and/or short duration, not allowing for the ability to evaluate antibiotic resistance over longer periods of time or in a real world setting.…”

Section: Discussionmentioning

confidence: 99%

“…Many randomized, controlled studies have confirmed that a prophylactic antimicrobial lock strategy reduces the incidence of CRBSI, and it has been suggested that, for every four patients treated with antimicrobial lock, one CRBSI is prevented (11)(12)(13)(14)(15). Furthermore, two small randomized, controlled trials showed a reduction in mortality on crude analysis by use of a prophylactic antimicrobial lock solution (16,17).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Moore

Besarab

Ajluni

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

Background and objectives Infection is the second leading cause of death in hemodialysis patients. Catheterrelated bloodstream infection and infection-related mortality have not improved in this population over the past two decades. This study evaluated the impact of a prophylactic antibiotic lock solution on the incidence of catheter-related bloodstream infection and mortality.Design, setting, participants, & measurements This prospective, multicenter, observational cohort study compared the effectiveness of two catheter locking solutions (gentamicin/citrate versus heparin) in 555 hemodialysis patients dialyzing with a tunneled cuffed catheter between 2008 and 2011. The groups were not mutually exclusive. Rates of catheter-related bloodstream infection and mortality hazards were compared between groups.Results The study population (n=555 and 1350 catheters) had a median age of 62 years (interquartile range=41-83 years), with 50% men and 71% black. There were 427 patients evaluable in the heparin period (84,326 days) and 322 patients evaluable in the antibiotic lock period (71,192 days). Catheter-related bloodstream infection in the antibiotic lock period (0.45/1000 catheter days) was 73% lower than the heparin period (1.68/1000 catheter days; P=0.001). Antibiotic lock use was associated with a decreased risk of catheter-related bloodstream infection compared with heparin (risk ratio, 0.23; 95% confidence interval, 0.13 to 0.38 after multivariate adjustment). Cox proportional hazards modeling found that antibiotic lock was associated with a reduction in mortality (hazard ratio, 0.36; 95% confidence interval, 0.22 to 0.58 in unadjusted analyses; hazard ratio, 0.32; 95% confidence interval, 0.14 to 0.75 after multivariate adjustment). The rate of gentamicin-resistant organisms decreased (0.40/1000 person-years to 0.22/1000 person-years) in the antibiotic lock period (P=0.01). ConclusionsThe results of this study show that the use of a prophylactic, gentamicin/citrate lock was associated with a substantial reduction in catheter-related bloodstream infection and is the first to report a survival advantage of antibiotic lock in a population at high risk of infection-related morbidity and mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Moore

Besarab

Ajluni

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

show abstract

“…This technique involves instilling a highly concentrated antimicrobial−anticoagulant solution at the end of a dialysis session which "locks" the catheter when it is not in use [38]. Although antibiotics can kill circulating planktonic microorganisms and treat CRBs, they cannot kill the biofilm pathogens that constitute the source of recurrent infections.…”

Section: Time For Preventing Recurrence Of Catheter-related Bacteremiamentioning

confidence: 99%

“…The antimicrobial concentration used to eradicate microorganisms within the biofilm should be 100−1,000 times greater compared with the required concentrations to eliminate planktonic organisms. Such concentrations cannot usually be reached by systemic antibiotic therapy but might be achieved with the use of AMLs [38].…”

Section: Time For Preventing Recurrence Of Catheter-related Bacteremiamentioning

confidence: 99%

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

Stefanidis

2009

Pediatr Nephrol

View full text Add to dashboard Cite

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.

show abstract

“…In order to reduce the risk of infection, a number of measures have been developed to improve the safety of venous line service, which include among the others, new types of plugs, "antibacterial" catheters, new types of dressings and filling catheter when not in use with an antibiotic or other agent of biocidal action, usually ethanol and recently taurolidine. The fundamental treatment method of catheter related bloodstream infections is to remove the catheter -source and at the same time foreign body sustaining infection -and appropriate antibiotic treatment (2). Systemically administrated antibiotics kill microorganisms in blood but do not destroy those inhabiting the catheter and infection symptoms recur in 20 to 50%, since the low concentration of the antibiotic in the solution administered intravenously by colonized catheter, does not allow its penetration into the biofilm, which ultimately leads to the removal of the central catheter (3).…”

mentioning

confidence: 99%

The Efficacy of Alcohol-Antibiotic Lock Therapy for Treatment of Catheter Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Ławiński

Majewska

Fołtyn

et al. 2015

Polish Journal of Surgery

View full text Add to dashboard Cite

In patients with chronic gastrointestinal tract failure, requiring access to the venous system, the subsequent catheter re-insertion are leading to large veins thrombosis impeding or preventing the insertion of another catheter and exposing patients to the risk of complications. Understanding the pathophysiology of catheter-related infections, enabled to use methods allowing to eradicate the source of infection without removal and replacement of central catheter with a new one. In our center, for many years we have been using an alternative method involving implementation of the alcohol-antibiotic lock in the treatment of infections. This method is based on the assumption that the destruction of biofilm with concentrated alcohol will enable antibiotic penetration and killing other microorganisms. Treatment with alcohol-antibiotic lock lasts from 8 to 10 days and involves filling the catheter with 96% alcohol followed by a solution of the antibiotic of high concentration. the aim of the study was to evaluate the efficacy of treatment of catheter-related bloodstream infections with two methods (catheter replacement with a new one and the alcohol-antibiotic lock therapy) in patients receiving home parenteral nutrition (HPN). material and methods. 428 HPN in the period from 1 January 2005 to 31 December 2010. Among which 240 (56%) of women with an average age of 56.5±16 years and 188 (44%) of men with an average age of 54±17 years. The indications to HPN were as follows: short bowel syndrome in 298 (70%) patients, multilevel obstruction of the gastrointestinal tract in 52 (12%), postoperative gastrointestinal fistulas in 48 (11.2%), malabsorption syndrome in 17 (4%), motility disorders in 6, cachexia in 4 and radiation enteritis in 3 patients. Results. In 247 (57.5%) from 428 patients, no episode of catheter-related bloodstream infection was found, while 181 were diagnosed with 352 episodes of catheter-related bloodstream infections. In 40 (9.4%) from 428 patients, 168 (47.8%) episodes have been found -almost a half. The mean duration of treatment of patients receiving home parenteral nutrition, starting from the first episode of catheterrelated bloodstream infection, in 48 patients treated with the lock was equal to 1053+748 days, and in 133 patients treated with catheter replacement was equal to 952+709 days (t-test p = 0.62). Conclusions. The survival time of patients treated with alcohol-antibiotic lock is the same as in patients treated with the catheter removal and insertion of the new one. The use of alcohol-antibiotic lock to treat catheter-related bloodstream infections in order to eradicate selected microorganisms that colonize the lumen and cause an infection, is as effective as catheter replacement with a new one. key words: home parenteral nutrition, alcohol-antibiotic lock therapy, catheter related bloodstream infections One of the conditions of success during longterm parenteral nutrition therapy is to avoid complications related to access to the venous system. Despite several methods reducing the ris...

show abstract

Antimicrobial Locks: Putting the Lock on Catheter Infections

Cited by 34 publications

References 51 publications

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

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

The Efficacy of Alcohol-Antibiotic Lock Therapy for Treatment of Catheter Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Contact Info

Product

Resources

About