Emergence of Gentamicin-Resistant Bacteremia in Hemodialysis Patients Receiving Gentamicin Lock Catheter Prophylaxis

Abstract

Results: Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006.Conclusions: Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.

Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial

“…Concerns remain over the risk of bacterial resistance developing when antibiotic solutions are used and the potential side effects of some antibiotics 35 . One randomized controlled study in 110 HD patients showed that taurolidine (1.35%)/citrate lock (4%) solution did not reduce bacteremia rates from any cause with t-HDC 36 .…”

Reducing Catheter-Related Infections in Hemodialysis Patients

“…Our observational study of .1400 patients followed for .4 years used heparin with a high-dose gentamicin locking solution (4 mg/ml) but did not have comparison resistance data from a historical control period (21). We used povidone-iodine rather than chlorhexidine as the skin antiseptic and covered the exit site with mupirocin, which has been associated with bacterial resistance (22).…”

Gentamicin-Resistant Infections in Peritoneal Dialysis Patients Using Topical Gentamicin Exit-Site Prophylaxis: A Report of Two Cases

“…In the largest of those studies, gentamicin use resulted in a significant reduction in catheter-related bacteremia, but infections with gentamicin-resistant organisms emerged within 6 months (14). Although those studies involved intraluminal instillation of gentamicin and not topical application, the findings suggest that chronic prophylactic exposure to aminoglycosides can breed resistance.…”