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

Abstract

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...

Consecuencias de la nutrición parenteral domiciliaria en adultos con síndrome de intestino corto: revisión exploratoria

“…Por otro lado, a pesar de recuperarse varios trabajos con el límite «Adulto», una vez conseguido el artículo completo, se observaba la aparición de menores de edad en dicho estudio, siendo uno de los criterios de exclusión. Como, por ejemplo, en las publicaciones de Ławiński et al (36), y de Galandiuk et al, (37).…”

SOP Management von Portinfektionen

“…Über einen Zeitraum von 10-14 Tagen sollte die Antibiotikalösung 1-2 × pro Tag gewechselt werden, im Anschluss sollten 3 aufeinander folgende Blutkulturen aus dem Port jeweils negativ sein [20,21,22]. In manchen Fällen wird auch eine 96 %ige Alkohollösung gefolgt von einer Antibiotikalösung genutzt [23].…”