Treatment of dialysis catheter-related Staphylococcus aureus bacteremia with an antibiotic lock: a quality improvement report.
BACKGROUND
Dialysis catheter-related bacteremia is often treated successfully by instilling an antibiotic-heparin solution into the catheter lumen (an antibiotic lock) in conjunction with systemic antibiotic therapy without removal of the catheter. The efficacy of this therapy is uncertain in Staphylococcus aureus bacteremia.


METHODS
Quality improvement report.


METHODS
113 catheter-dependent hemodialysis outpatients with S aureus catheter-related bacteremia treated with a standardized antibiotic lock protocol. Data for all patients with catheter-related bacteremia are recorded in a prospective database.


METHODS
In conjunction with systemic antibiotic therapy (vancomycin for methicillin-resistant S aureus or cefazolin for methicillin-sensitive S aureus), an antibiotic lock was instilled into each catheter lumen after each dialysis session for 3 weeks.


METHODS
Treatment failure is defined as persistent fever after 48 hours of antibiotic therapy or recurrent S aureus bacteremia within 90 days. Clinical cure is defined as resolution of fever and no recurrence of bacteremia. Major infection-related complications within 6 months were documented.


RESULTS
The catheter could not be salvaged in 67 patients (59%) because of persistent fever in 40 patients and recurrent bacteremia in 27 patients. A clinical cure was achieved in 46 patients (41%). A serious complication of catheter-related bacteremia occurred in 9.7% of all patients (11 of 113 patients). Serious complications were observed in 25% of patients (10 of 40 patients) with persistent fever, but only 1.4% of all other patients (1 of 73 patients; P < 0.0001).


CONCLUSIONS
This was a single-center study. Serum antibiotic levels were not measured.


CONCLUSIONS
Routine antibiotic lock therapy is not appropriate for patients with S aureus catheter-related bacteremia. Serious complications occur primarily in patients with persistent fever.
Division of Nephrology, University of Alabama at Birmingham, AL, USA.
Ivan D
ID
Maya
Donna
D
Carlton
Erin
E
Estrada
Michael
M
Allon
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology* / Q000592:standards; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011786:Quality Control; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*
D000900:Anti-Bacterial Agents