Maya ID, Carlton D, Estrada E, Allon M. Treatment of dialysis catheter-related Staphylococcus aureus bacteremia with an antibiotic lock: a quality improvement report.
Am J Kidney Dis 2007;
50:289-95. [PMID:
17660030 DOI:
10.1053/j.ajkd.2007.04.014]
[Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 04/09/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND
Dialysis catheter-related bacteremia is often treated successfully by instilling an antibiotic-heparin solution into the catheter lumen (an antibiotic lock) in conjunction with systemic antibiotic therapy without removal of the catheter. The efficacy of this therapy is uncertain in Staphylococcus aureus bacteremia.
DESIGN
Quality improvement report.
SETTING & PARTICIPANTS
113 catheter-dependent hemodialysis outpatients with S aureus catheter-related bacteremia treated with a standardized antibiotic lock protocol. Data for all patients with catheter-related bacteremia are recorded in a prospective database.
QUALITY IMPROVEMENT PLAN
In conjunction with systemic antibiotic therapy (vancomycin for methicillin-resistant S aureus or cefazolin for methicillin-sensitive S aureus), an antibiotic lock was instilled into each catheter lumen after each dialysis session for 3 weeks.
MEASURES
Treatment failure is defined as persistent fever after 48 hours of antibiotic therapy or recurrent S aureus bacteremia within 90 days. Clinical cure is defined as resolution of fever and no recurrence of bacteremia. Major infection-related complications within 6 months were documented.
RESULTS
The catheter could not be salvaged in 67 patients (59%) because of persistent fever in 40 patients and recurrent bacteremia in 27 patients. A clinical cure was achieved in 46 patients (41%). A serious complication of catheter-related bacteremia occurred in 9.7% of all patients (11 of 113 patients). Serious complications were observed in 25% of patients (10 of 40 patients) with persistent fever, but only 1.4% of all other patients (1 of 73 patients; P < 0.0001).
LIMITATIONS
This was a single-center study. Serum antibiotic levels were not measured.
CONCLUSIONS
Routine antibiotic lock therapy is not appropriate for patients with S aureus catheter-related bacteremia. Serious complications occur primarily in patients with persistent fever.
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