A randomized, controlled trial of a new vascular catheter flush solution (minocycline-EDTA) in temporary hemodialysis access.
OBJECTIVE
We previously demonstrated that minocycline-EDTA was efficacious at preventing catheter-related bloodstream infections (BSIs) in three patients with recurrent infections. This study compared heparin with minocycline-EDTA as flush solutions used among dialysis patients with central venous catheters, a high-risk group for catheter-related BSI.


METHODS
Patients were enrolled within 72 hours of catheter insertion and randomized to receive heparin or minocycline-EDTA as a flush after each dialysis session. Each syringe containing flush solution was wrapped in orange plastic to conceal the type of solution it contained. Patients were observed for evidence of infection and catheter thrombosis. After catheters were removed, cultures were performed to determine whether microbial colonization had occurred.


RESULTS
During a 14-month period, 60 patients were enrolled (30 in each group). The two groups had similar demographics and underlying diseases. Catheter survival at 90 days was 83% for the minocycline-EDTA group versus 66% for the heparin group (P = .07). Significant catheter colonization, a surrogate measure of catheter-related infection, was significantly more frequent in the heparin group (9 of 14 vs 1 of 11; P = .005). There was only one catheter-related bacteremia and it occurred in the heparin group.


CONCLUSIONS
When compared with heparin, minocycline-EDTA had a better 90-day catheter survival (P = .07) and a decreased rate of catheter colonization. This pilot study warrants a larger prospective, randomized trial.
Bleyer
Anthony J
AJ
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. ableyer@wfubmc.edu
Mason
Lori
L
Russell
Gregory
G
Raad
Issam I
II
Sherertz
Robert J
RJ
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004311:Double-Blind Method; D004338:Drug Combinations; D004492:Edetic Acid / Q000008:administration & dosage*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage*; D009657:North Carolina / Q000453:epidemiology; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis; D007507:Therapeutic Irrigation / Q000379:methods*; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D004338:Drug Combinations; D006493:Heparin; D004492:Edetic Acid; D008911:Minocycline