Prophylaxis of catheter-related bacteremia using tissue plasminogen activator-tobramycin locks.
This retrospective study was designed to investigate the effectiveness of tissue plasminogen activator-tobramycin antibiotic lock solutions (TPA/tobra ABLs) for prophylaxis of catheter-related bacteremia (CRB) in high-risk children on long-term hemodialysis. During the first 6 months (Era 1), the high-risk group was defined. These patients received TPA/tobra ABL prophylaxis after every hemodialysis treatment for the next 6 months (Era 2). The prophylaxis regimen was applied once a week for the third 6-months period (Era 3). Primary endpoints were CRB and infection-free catheter survival. There were 16,412 catheter days, and 95 cases of CRB in 43 children. The incidence of CRB was 5.8/1,000 catheter days. Significant decrease in the incidence of CRB was observed when prophylactic TPA/tobra ABL was used in the high-risk group (P = 0.0201). There was a tendency for less CRB when prophylactic ABL was applied after every hemodialysis session compared with once a week (P = 0.0947). The catheters in the high-risk group had shorter survival times than those in the average-risk group in Era 1 (P < 0.0001). However, both the overall and infection-free survival of the catheters in the high-risk group significantly improved while the patients were receiving TPA/tobra ABL prophylaxis, becoming similar to the outcomes of the catheters in the average-risk group and exhibiting statistically non-significant differences (P = 0.5571 and P = 0.9711, respectively). In conclusion, the TPA/tobra ABLs may effectively reduce the rate of CRB, and this may prolong both the overall and infection-free survival times of the catheters in the high-risk group.
Onder
Ali Mirza
AM
West Virginia University, WVU/HSC, Morgantown, 26506-9214, USA. alim_md@hotmail.com
Chandar
Jayanthi
J
Billings
Anthony
A
Simon
Nancy
N
Gonzalez
JoAnn
J
Francoeur
Denise
D
Abitbol
Carolyn
C
Zilleruelo
Gaston
G
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002648:Child; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014031:Tobramycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D006454:Hemoglobins; D007552:Isotonic Solutions; D010281:Parathyroid Hormone; D012709:Serum Albumin; D010758:Phosphorus; D005293:Ferritins; D010959:Tissue Plasminogen Activator; D002118:Calcium; D014031:Tobramycin