Saving infected catheters: why and how.
Conventional management of dialysis catheter-related bacteremia involves administration of systemic antibiotics, as well as removal of the infected catheter. This approach adds burdensome and expensive procedures, and creates short-term problems for dialysis access. Recent research has shown that bacterial biofilms form routinely in the catheter lumen, and act as the nidus for bacteremic episodes. Instillation of a concentrated antibiotic-anticoagulant solution into the catheter lumen ('antibiotic lock') may permit successful treatment of the infection, while salvaging the patient's catheter. A number of recent studies have reported the success of an antibiotic lock protocol in about two thirds of cases of catheter-related bacteremia. Catheter replacement is only performed in those patients with protocol failures (persistent fever or positive surveillance blood cultures). In conclusion, routine application of an antibiotic lock protocol may reduce substantially the need for routine catheter replacement in hemodialysis patients with catheter-related bacteremia.
Allon
Michael
M
Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL 035294, USA. mdallon@uab.edu
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000628:therapy; D002408:Catheters, Indwelling / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects*
D000900:Anti-Bacterial Agents