Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study.
BACKGROUND
Infection is one of the main problems associated with long-term central venous catheters. This study assesses the effectiveness of antibiotic-lock therapy (ALT) for treating catheter-related bacteraemia (CRB).


METHODS
CRB was defined as quantitative blood culture counts through any catheter lumen 5-fold greater than concurrent peripheral blood culture, and qualitative blood culture positive for the same microorganism in all samples. Systemic treatment and ALT were started simultaneously using vancomycin (2000 mg/L) for Gram-positive organisms, and ciprofloxacin or amikacin (2000 mg/L) for Gram-negative bacilli. Heparin was added to ALT. Effectiveness was assessed by clinical and microbiological criteria. Cure was defined as negative blood cultures at both sites without catheter removal at 1 month after the completion of therapy.


RESULTS
A total of 115 episodes of CRB in 98 patients were analysed. Catheters were used for chemotherapy (50 episodes), haemodialysis (37), total parenteral nutrition (24) and combined chemotherapy and nutrition (4). Median time from catheter placement to CRB onset was 105 days (IQ range 26-210). Aetiologies included Gram-positive organisms [56 coagulase-negative staphylococci (CoNS), 20 Staphylococcus aureus and 5 other organisms] in 81 episodes (70%), Gram-negative bacilli (11 Escherichia coli, 5 Pseudomonas aeruginosa and 10 other organisms) in 26 (23%) and polymicrobial in 8 (7%). A total of 94 episodes were cured (82%). There were 21 therapeutic failures: 9 S. aureus (1 related death), 9 CoNS, 1 P. aeruginosa, 1 Proteus vulgaris and 1 polymicrobial. Median catheter follow-up in therapeutic success was 168 days (range 7-2740).


CONCLUSIONS
ALT combined with systemic antibiotics seems to be effective for treating CRB, especially in Gram-negative and CoNS episodes. S. aureus CRB had an elevated rate of therapeutic failure.
Fernandez-Hidalgo
Nuria
N
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Medicine Department Barcelona, Spain. nufernan@gmail.com
Almirante
Benito
B
Calleja
Raquel
R
Ruiz
Isabel
I
Planes
Ana M
AM
Rodriguez
Dolors
D
Pigrau
Carles
C
Pahissa
Albert
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000008:administration & dosage / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling / Q000382:microbiology*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006493:Heparin / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D002939:Ciprofloxacin; D014640:Vancomycin; D000583:Amikacin; D006493:Heparin