Treatment of Catheter-related Bacteremia with an Antibiotic Lock Protocol in Hemodilaysis Patients

Lee, Hae Ri; Lee, Young Ki; Song, Young Lim; Kim, Su Jin; Joo, Min Ha; Kim, Seong Gyun; Oh, Ji Eun; Seo, Jang Won; Koo, Ja Ryong; Kim, Hyung Jik; Noh, Jung Woo; Shin, Sang June

Abstract

BACKGROUND
Catheter-related bacteremia is a frequent complication among hemodialysis patients using a tunneled cuffed catheter. The standard therapy of catheter-related bacteremia involves both systemic antibiotics and catheter replacement. This study was performed to evaluate the effect of antibiotic lock therapy in conjugation with systemic antibiotics without catheter removal on catheter-related bacteremia. METHODS: Thirty six chronic hemodialysis patients with tunneled cuffed catheter were monitored for infection between July 2001 and July 2005. We analyzed the efficacy of antibiotic lock protocol compared with systemic antibiotics alone. RESULTS: Twenty-nine episodes of catheter-related bacteremia occurred in 27 patients during the study periods. The incidence of catheter-related bacteremia was 1.5 episodes/1000 catheter-days. A single gram-positive coccus grew in the 16 cases (55.2 %), and gram-negative organisms grew in the 69 cases (31.0%). Sixteen of 18 patients (88.9%) treated with antibiotic lock protocol had successful catheter salvage versus only 6 of the 11 patients (54.5%) treated with systemic antibiotics alone (p=0.05). Three patients with Burkholderia pickettii and a patient with Acinetobactor calcoaceticus-baumannii complex were treated with antibiotic lock protocol with systemic ciprofloxacin and imipenem, respectively. CONCLUSION: This study suggests that antibiotic lock protocol in eradicating catheter-related bacteremia is effective treatment without requiring catheter replacement.