Treatment of long-term catheter-related bacteremia with antibiotic lock therapy

Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
Journal of Antimicrobial Chemotherapy (Impact Factor: 5.31). 11/2006; 58(4):816-21. DOI: 10.1093/jac/dkl318
Source: PubMed


Bacteraemia is a major complication associated with the use of long-term intravascular catheters. Conservative treatment using antibiotic-lock therapy (ALT) has been shown to be useful in some studies, but the evidence supporting its impact in clinical care is still scarce.
We evaluated the outcome of the episodes of catheter-related bacteraemia (CRB) associated with long-term intravascular devices used for chemotherapy or parenteral nutrition and that were managed with ALT during a 44 month period in our hospital. Episodes of CRB associated with catheters implanted in the same department during the same period, and that were managed with only systemic antibiotics were used as a control group. Antibiotic-lock solution consisted of a heparin solution of 20 IU/mL including vancomycin (for Gram-positive microorganisms) or ciprofloxacin or gentamicin (for Gram-negative bacilli), all at a concentration of 2 mg/mL. ALT was used for a minimum of 8-12 h/day, during 5-14 days. Effectiveness was assessed by clinical and microbiological criteria.
A total of 801 long-term intravascular devices were placed in 105 patients during this period. There were 127 episodes of bacteraemia documented in these patients, with 92 being CRB. Of these, 48 episodes fulfilled inclusion criteria for the analysis. Nineteen episodes were treated with ALT plus systemic antibiotics, and 29 episodes were treated only with systemic antibiotics. Isolated microorganisms were similar in the two groups. The catheter had to be removed during therapy in one episode in the antibiotic-lock group and in seven episodes in the control group. Relapse of the bacteraemia with the same microorganism after stopping therapy was observed in two and three patients in the study group and the control group, respectively. Overall, successful treatment was achieved in 84% and 65% of the episodes in the antibiotic-lock group and the control group, respectively (P = 0.27).
ALT appears as an effective conservative treatment in the management of CRB associated with long-term intravascular devices (84% in the present series), especially in infections caused by coagulase-negative staphylococci.

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Available from: Lucía García-San Miguel, Nov 23, 2015
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    • "Addition of lactated Ringer’s solution for calcium supplementation to reconstituted daptomycin is required for bioactivity.23 In vitro reports against biofilm-producing pathogens and data in a prophylactic modality support the utilization of both daptomycin and gentamicin in lock solutions.6,10,22–24 Ethanol as a 70% solution was also used in 3 cases in our study, twice in combination with vancomycin (vancomycin and ethanol locked separately on alternating days). "
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    ABSTRACT: Antimicrobial 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. To evaluate the outcomes associated with ALT as adjunctive treatment of CRBSI. This 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. Twenty-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). ALT used as an adjunct to systemic therapy for adequate duration in CRBSI can achieve CVC sterilization and retainment without subsequent infectious complications.
    Full-text · Article · Jun 2010 · Clinical Pharmacology: Advances and Applications
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    • "The utility of antimicrobial locks in the treatment of long-term intravascular device-related BSIs has been suggested in a recent randomised, blinded, multicentre trial [9]. The overall cure rate in our study was 88.6%, which is in accordance with previous reports on the use of antimicrobial locks for the treatment of CoNS catheter-related BSIs [3] [4]. Vancomycin is the most frequent antimicrobial used, although teicoplanin has also been used but with irregular results [10] [11] [12]. "
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    ABSTRACT: The aim of this study was to analyse the effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of coagulase-negative staphylococci (CoNS) venous access port-related bloodstream infection (BSI). The study included 44 consecutive patients during a 36-month prospective case-series study. The primary endpoint was failure to cure. Treatment was successful in 39 patients. At the end of the study, the cumulative port survival rate was 100% in the teicoplanin lock group compared with 77% in the vancomycin lock group (P=0.06). In the Cox regression analysis, fever beyond 48 h of treatment was a significant predictor of treatment failure (P=0.02). Use of vancomycin or teicoplanin locks had an effectiveness of 88.6% in the treatment of CoNS port-related BSI. Teicoplanin locks reduced the failure rate from 18.5% to 0% compared with vancomycin locks. The presence of fever after beginning antimicrobial lock therapy was associated with treatment failure.
    Full-text · Article · Sep 2009 · International journal of antimicrobial agents

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