Comparison of early versus late use of antibiotic locks in the treatment of catheter-related bacteremia.
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.
Onder
Ali Mirza
AM
Division of Pediatric Nephrology, West Virginia University/Health Sciences Center, P.O. Box 9214, Morgantown, WV 26506-9214, USA. aonder@hsc.wvu.edu
Chandar
Jayanthi
J
Billings
A A
AA
Simon
Nancy
N
Diaz
Rosa
R
Francoeur
Denise
D
Abitbol
Carolyn
C
Zilleruelo
Gaston
G
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
D000900:Anti-Bacterial Agents