Effect of catheter-lock solutions on catheter-related infection and inflammatory syndrome in hemodialysis patients: heparin versus citrate 46% versus heparin/gentamicin.
OBJECTIVE
Prevention strategies are emerging with the use of catheter-lock solutions (CLS) to prevent catheter-related infections. We compared 3 CLS: heparin, citrate (46%) and heparin/gentamicin (H/G).


METHODS
Three periods of 6 months using the three CLS were compared.


RESULTS
265 catheters were studied. The CRI rate per 1,000 catheter-days was 2.9 for heparin, 3.4 for citrate and 0.4 for H/G. The free-infection catheter survival tended to be higher with H/G (log-rank test, p = 0.06) and the CRP had a significant decreasing course (p = 0.03). Since 2006 H/G was used as CLS in our dialysis unit. The resistance to gentamicin of Enterobacteriaceae increased in the nephrology department and in the entire hospital. On the other hand, the resistance of Staphylococcus aureus to gentamicin dropped to nil.


CONCLUSIONS
CLS with heparin/gentamicin tended to decrease CRI compared to citrate 46% and heparin and frankly improved the CRP course after catheter insertion. Gentamicin resistance should be monitored.
Venditto
Marcia
M
Department of Nephrology, Assistance publique hôpitaux de Paris, Groupe hospitalier Pitié Salpétrière, Paris, France.
du Montcel
Sophie Tezenas
ST
Robert
Jérôme
J
Trystam
David
D
Dighiero
Jean
J
Hue
Danièle
D
Bessette
Christelle
C
Deray
Gilbert
G
Mercadal
Lucile
L
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000378:metabolism; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D019343:Citric Acid / Q000008:administration & dosage*; D018572:Disease-Free Survival; D024881:Drug Resistance, Bacterial; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D019343:Citric Acid; D006493:Heparin; D002097:C-Reactive Protein