BACKGROUND AND OBJECTIVES: Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related blood stream infections (CRIs), but there are no data regarding the long-term consequences of this practice. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Over a 4-year period, from October 1, 2002, to September 30, 2006, we initiated a gentamicin and heparin lock (GHL) protocol in 1410 chronic hemodialysis patients receiving dialysis through a tunneled catheter in eight outpatient units. RESULTS: Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006. CONCLUSIONS: Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.
BACKGROUND AND OBJECTIVES: Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related blood stream infections (CRIs), but there are no data regarding the long-term consequences of this practice. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Over a 4-year period, from October 1, 2002, to September 30, 2006, we initiated a gentamicin and heparin lock (GHL) protocol in 1410 chronic hemodialysis patients receiving dialysis through a tunneled catheter in eight outpatient units. RESULTS: Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006. CONCLUSIONS: Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.
Authors: Christopher J Crnich; Jeremy A Halfmann; Wendy C Crone; Dennis G Maki Journal: Infect Control Hosp Epidemiol Date: 2005-08 Impact factor: 3.254
Authors: Albert Power; Neill Duncan; Seema K Singh; Wendy Brown; Elizabeth Dalby; Claire Edwards; Kathleen Lynch; Virginia Prout; Tom Cairns; Megan Griffith; Adam McLean; Andrew Palmer; David Taube Journal: Am J Kidney Dis Date: 2009-04-25 Impact factor: 8.860
Authors: Saib A Abbas; Imad A Haloob; Susan L Taylor; Elizabeth M Curry; Bruce B King; Walter M Van der Merwe; Mark R Marshall Journal: Am J Kidney Dis Date: 2009-01-15 Impact factor: 8.860
Authors: Dwayne A Pierce; John C Williamson; Vicki S Mauck; Gregory B Russell; Elizabeth Palavecino; John M Burkart Journal: Perit Dial Int Date: 2012-02-01 Impact factor: 1.756