Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia.
BACKGROUND
Catheter-restricted antibiotic lock solutions were found to be effective in the prevention of catheter-related bacteremia (CRB), but insufficient data are available about the ideal agent and dose. We hypothesized that a low concentration of gentamicin would be as effective as the high doses studied in the past.


METHODS
In this prospective, open-labeled, randomized, clinical trial of patients on long-term hemodialysis therapy, patients were randomly assigned to administration of an antibiotic lock solution of gentamicin/citrate (4 mg/mL), minocycline/EDTA, or the control solution of heparin. Patients were followed up until the study end point of CRB was reached or a censoring event occurred. Interim data analysis was performed after 6 months to assess data safety; efficacy was noted and the study was terminated early.


RESULTS
Sixty-two patients were enrolled into the study, evenly distributed in 3 arms, with data from 1 patient excluded from analysis. Seven of 20 patients in the heparin group (4.0 events/1,000 catheter days), 1 of 21 patients in the minocycline group (0.4 events/1,000 catheter days), and none of 20 patients in the gentamicin group developed bacteremia. Results were statistically significant by using 2-tailed Fisher exact test; heparin versus gentamicin, P = 0.008, and heparin versus minocycline, P = 0.020.


CONCLUSIONS
Antibiotic lock solutions are superior to the standard heparin lock alone in the prevention of CRBs, and low-dose gentamicin solution has efficacy similar to that of greater concentrations used in previous studies.
Nori
Uday S
US
Division of Nephrology, Henry Ford Hospital, Detroit, MI 48202, USA.
Manoharan
Anup
A
Yee
Jerry
J
Besarab
Anatole
A
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D002404:Catheterization / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D013211:Staphylococcus aureus
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D008911:Minocycline