title: Comparison of early versus late use of antibiotic locks in the treatment of catheter-related bacteremia.
abstract: OBJECTIVE
  This retrospective study compared the effectiveness of the timing of the antibiotic locks to clear catheter-related bacteremia in children on chronic hemodialysis.
  
  
  METHODS
  The early antibiotic lock group received antibiotic locks along with systemic antibiotics from the very beginning of catheter-related bacteremia. The late antibiotic lock group was given only systemic antibiotics initially, and antibiotic locks were used late in the infection if the catheter-related bacteremia could not be cleared after resolution of symptoms.
  
  
  RESULTS
  There were 264 catheter-related bacteremias in 79 children during 6 yr of observation. Early antibiotic locks were able to clear catheter-related bacteremia and resolve the symptoms more effectively without the need for catheter exchange when compared with late antibiotic locks. A total of 84 catheter-related bacteremias required wire-guided exchange of the catheters. Late antibiotic locks required wire-guided catheter exchange more frequently than the early antibiotic locks. The post-catheter-related bacteremia infection-free survival of the catheters after wire-guided exchange were significantly longer than those of both antibiotic lock groups. Recurrence of catheter-related bacteremia within 45 d after wire-guided exchange occurred at similar rates compared with the antibiotic lock groups.
  
  
  CONCLUSIONS
  Antibiotic locks are significantly more effective in clearing catheter-related bacteremia when used early in infection, diminishing the need for catheter exchange. Wire-guided exchange has a late-onset advantage for infection-free survival compared with catheter in situ treatment. The recurrence rates in the first 45 d after catheter-related bacteremia are similar regardless of the treatment strategy.
authors.affiliation: Division of Pediatric Nephrology, West Virginia University/Health Sciences Center, P.O. Box 9214, Morgantown, WV 26506-9214, USA. aonder@hsc.wvu.edu
authors.forename: Ali Mirza
authors.initials: AM
authors.lastname: Onder
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: A A
authors.initials: AA
authors.lastname: Billings
authors.forename: Nancy
authors.initials: N
authors.lastname: Simon
authors.forename: Rosa
authors.initials: R
authors.lastname: Diaz
authors.forename: Denise
authors.initials: D
authors.lastname: Francoeur
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D004334:Drug Administration Schedule; D004866:Equipment Contamination; D004867:Equipment Design; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents