Korean J Nephrol.
2005 Jan;24(1):108-117.
Prevention of Uncuffed Hemodialysis Catheter-Related Bacteremia (CRB) Using Antibiotic Lock Technique (ALT): A Randomized Controlled Trial
- Affiliations
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- 1Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
- 2Department of Internal Medicine, Gang Neung Asan Hospital, College of Medicine, University of Ulsan, Gang Neung, Korea.
- 3Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea. wonyong@korea.ac.kr
Abstract
- BACKGROUND
Because of the rate of infection, NKF-K/DOQI guidelines recommended that uncuffed catheter (UC) should be used for no longer than 3 weeks. However, from data of the Dialysis Outcomes and Practice Patterns Study (DOPPS), it was recognized that 48% of new HD patients in US and 75 % in Europe use UC as temporary access. ALT has been recommended as a prevention of CRB in these patients. We prospectively evaluated the efficacy of catheter-restricted filling with Antibiotic Lock Solution in preventing CRB. METHODS: One hundred twenty new hemodialysis patients requiring temporary catheter while waiting for placement and maturation of an arteriovenous fistula were enrolled. Patients were excluded if they had clinical or microbiological evidence of infection or already received antibiotics. Patients with uncuffed, right internal jugular vein catheter were randomly assigned to receive either antibiotic-heparin lock solution (cefazolin 10 mg/mL, gentamicin 5 mg/ mL, heparin 1, 000 unit/mL) or heparin lock solution (heparin 1, 000 unit/mL) as a catheter lock solution during interdialytic period. The end point of the trial was CRB. RESULTS: CRB developed in seven (11.7%) patients receiving heparin lock solution (S. aureus 2, S. epidermidis 5) whereas one patient receiving ALT had S. aureus bacteremia. CRB rates per 1, 000 catheter-days were 0.44 in the ALT group versus 3.12 in the heparin lock solution group (p=0.031). Kaplan-Meier analysis also showed CRB-free catheter survival is longer in ALT group. CONCLUSION: These results showed that ALT could be an effective strategy for the reduction of CRB rate in hemodialysis patients with UC.
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