The antibiotic-lock technique for therapy of 'highly needed' infected catheters.

Catheter-related bacteremia is a major complication in patients with long-term surgically implanted central venous catheters, which are difficult and expensive to remove. Conventional treatment fails in a significant number of cases, resulting in removal of the device. The antibiotic-lock technique involves instilling a high concentration of antibiotic into the catheter lumen, and allowing it to remain for a period of time. Results of several open studies, mainly involving patients receiving home parenteral nutrition, indicate that this method may be regarded as an alternative to the conservative treatment of noncomplicated intraluminal catheter-related bacteremia, in which infection may be treated without catheter removal. However, many questions about this therapeutic method remain to be resolved, including appropriate concentration of antibiotics, duration of treatment, and whether or not concomitant systemic antibiotic therapy is necessary. Prospective studies comparing the antibiotic-lock technique with conventional treatment are needed.