Clinical outcomes of antimicrobial lock solutions used in a treatment modality: a retrospective case series analysis

Abstract

BackgroundAntimicrobial lock therapy (ALT) may be considered as adjunctive therapy in the treatment of catheter-related bloodstream infections (CRBSI) when catheter removal is not a favorable option.ObjectiveTo evaluate the outcomes associated with ALT as adjunctive treatment of CRBSI.MethodsThis was a 24-month retrospective case series analysis evaluating patients treated for more than 24 hours with ALT. The primary outcome was blood culture sterilization for 30 days posttherapy. The impact of ALT duration and time to initiation on central venous catheter (CVC) salvage were evaluated. Logistic regression modeled the association between ALT and sterilization rates, with a prespecified level of significance (α) of 0.1.ResultsTwenty-six cases were included in data analysis. Patients included ranged from 5 months to 82 years of age; 77% of patients were receiving total parenteral nutrition or chemotherapy. The majority of patients received vancomycin, daptomycin, or gentamicin combined with heparin in a lock solution. Blood culture sterilization was achieved in 69.2% of cases, and sterilization plus CVC retention was achieved in 11 cases (42.3%). Longer durations of ALT (≥9 days) were significantly correlated with blood culture sterilization (odds ratio = 1.367, P = 0.077).ConclusionALT used as an adjunct to systemic therapy for adequate duration in CRBSI can achieve CVC sterilization and retainment without subsequent infectious complications.

Antimicrobial lock therapy in central-line associated bloodstream infections: a systematic review

“…Gentamicin ALT is typically administered at 2.5 or 5 mg/ml concentrations [23]. However, data about its efficacy are contradictory, as Lee et al [24] showed that it was not effective over 5 days of ALT in in vitro biofilm models, nor were cefazolin, nafcillin or erythromycin, while Fernandez-Hidalgo et al [25] found that gentamicin ALT was generally effective on S. aureus biofilms in rabbit catheters.…”

“…Duration of locks varies from 3 to 27 days and ALT is generally associated with systemic treatment [6]. Indeed, Bookstaver et al [23] showed that active systemic therapy, associated with vancomycin ALT, alone or together with gentamicin or ethanol, allowed good success rates while avoiding catheter removal.…”

“…Bookstaver et al [23] evaluated clinical outcomes with ALT as adjunctive treatment to systemic therapy in case of CLABSI, in a small series of patients. The main pathogens were CoNS (35 %), MRSA (23 %) and GNB (23 %), while the main drugs used for ALT were DPT, vancomycin and gentamicin.…”

Efficacy of daptomycin lock therapy in the treatment of bloodstream infections related to long-term catheter

“…This [11] found DPT systemic and lock therapy to be effective in 11 of 13 patients with CRBSI. Bookstaver et al [12] reported the efficacy of systemic and lock therapy in 26 patients with Gram-positive catheter-related infections using different antibiotics. In particular, DPT was used in six patients, always successfully.…”

Comparative in vitro efficacies of ethanol-, EDTA- and levofloxacin-based catheter lock solutions on eradication of Stenotrophomonas maltophilia biofilms

“…excelsiormedical.com). Furthermore, recent studies have shown a benefit from ELT in treating and preventing CRBIs (Bookstaver et al, 2010;Broom et al, 2009;Cober et al, 2011;Mouw et al, 2008;Sanders et al, 2008). As a result of broad interest in ELT at the Nebraska Medical Center, Maiefski et al (2009) devised ELT recommendations for prevention and treatment of CRBSI based on the findings in their review.…”