Minocycline-EDTA Lock Solution Prevents Catheter-Related Bacteremia in Hemodialysis

Abstract

There is growing concern about the development of antibacterial resistance with the use of antibiotics in catheter lock solutions. The use of an antibiotic that is not usually used to treat other serious infections may be an alternative that may reduce the clinical impact should resistance develop. We conducted a randomized controlled trial to compare a solution of minocycline and EDTA with the conventional unfractionated heparin for the prevention of catheter-related bacteremia in hemodialysis patients during a period of 90 d. The study included 204 incident catheters (27.8% tunneled); 14 catheters were excluded because of early dysfunction and 3 because of protocol violations. We observed catheter-related bacteremia in 19 patients in the heparin group (4.3 per 1000 catheter-days) and in 5 patients in the minocycline-EDTA group (1.1 per 1000 catheter-days; P ϭ 0.005). We did not detect a significant difference in the rate of catheter removal for dysfunction. Catheter-related bacteremia-free survival was significantly higher in the minocycline-EDTA group than in the heparin group (P ϭ 0.005). In conclusion, a minocycline-EDTA catheter lock solution is effective in the prevention of catheter-related bacteremia in hemodialysis patients. 22: 193922: -194522: , 201122: . doi: 10.1681 Despite all efforts to reduce the use of catheters in hemodialysis units because of related complications, the frequency of catheter use continues to rise, probably in consequence of the tendency to place native arteriovenous fistula at all cost. 1,2 The main complications related to catheter use are dysfunction (inadequate blood flow) and infection. The type of infections comprise exit-site infection, tunnel infection, and bacteremia. Despite the fact that exit-site and tunnel infections are the most common complications, 3,4 catheter-related bacteremia (CRB) is the most serious one, representing a barrier to long-term catheter use and emerging as a significant cause of morbidity and mortality. 5 Some studies have demonstrated that in patients using a hemodialysis catheter, the risk of death is 1.5-to threefold higher when compared with patients with a primary arteriovenous fistula. [5][6][7] Moreover, in a large cohort, the occurrence of septicemia was associated subsequently with higher cardiovascular morbidity and mortality. 8 A recent clinical trial addressing the prevention of CRB demonstrated that 12% of bacteremia-episodes resulted in death. 9 For these reasons, the prevention of CRB has become one of the major challenges in the routine care of hemodialysis patients. J Am Soc NephrolIn recent years several studies have employed specific locking solutions instead of the usual hep-

Evaluation of the Impact of Nutritional Support on Quality of Life and Morbidity Indicators in Hemodialysis

“…It is well grounded in the literature that the catheter as access for HD, is associated with increased infections, and higher morbidity and mortality [18,19]. A study by Taylor, et al found that the relative risk of bacteremia in those using catheter for HD was estimated to be ten times greater than in patients with AVF.…”

Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol

“…Finally, the addition of 25% ethanol has been shown to add to the activity of M-EDTA in rapidly eradicating Candida organisms in biofilm and allowing the triple combination to achieve complete eradication of all organisms within a 2-h lock exposure (22,23). An M-EDTA lock solution without ethanol was found to prevent catheter-related bacteremia and colonization in clinical trials involving hemodialysis patients and cancer patients (20,21,30,31). However, in all of these preventive clinical trials, the lock time was Ͼ24 h. To date, there have been no clinical trials demonstrating the efficacy of M-EDTA in 25% ethanol solution, particularly with a lock time of Յ2 h. The results of this current trial demonstrate that locking the CVCs of 30 patients with documented CLABSI/CRBSI caused by various bacteria resulted in the successful management of this bloodstream infection with systemic antibiotics without any associated mechanical or infectious complications.…”

Infecção Da Corrente Sanguínea Relacionada a Cateter Venoso Central Para Hemodiálise: Revisão Integrativa

“…5/2011 (17) Comparar uma solução de minociclina e EDTA com heparina não fraccionada para a prevenção de bacteremia relacionada com o cateter em doentes submetidos à hemodiálise.…”