title: Influence of intralumenal and antibiotic-lock of vancomycin on the rate of catheter removal in the patients with permanent hemodialysis catheters.
abstract: Infection of permanent catheters (Permcath) in hemodialysis (HD) patients can lead to catheter removal. The successful use of an antibiotic-lock to treat infection has reported good results in the treatment of catheters' infections. This study was designed to evaluate the impact of the intraluminal vancomycin in comparison with intravenous antibiotic administration. We included 67 (37 males and 30 females) chronic HD patients requiring Permcath insertion at our tertiary care hospital from July 2004 to June 2007. We studied two subgroups: an intervention group, which received 500 mg vancomycin infusion via both lumens of the Permcath and antibiotic lock of 1.5 mL each 48 hours with 1 g i.v. ceftriaxone every 12 hours for 7 days, followed by oral antibiotics according to the culture for three weeks; and a control group, which received 500 mg intravenous vancomycin with daily 100-150 mg amikacin intravenously. Our endpoint was the rate of catheter removal. The patients characteristics including age, sex, time of insertion of the catheter and number of dialysis sessions per week did not differ between both subgroups. Of 28 patients in the intervention group, there was one catheter removal, and of 39 patients in the control group, there were 22 catheter removals, (P< 0.001). We conclude that administration of vancomycin as an antibiotic-lock in permcaths is more effective than its mere intravenous injection, and can increase the life span of catheters.
authors.affiliation: Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Beigi
authors.forename: Sahar
authors.initials: S
authors.lastname: Khansoltani
authors.forename: Hassan
authors.initials: H
authors.lastname: Masoudpour
authors.forename: Abdol Amir
authors.initials: AA
authors.lastname: Atapour
authors.forename: Afrooz
authors.initials: A
authors.lastname: Eshaghian
authors.forename: Elham Fatemeh
authors.initials: EF
authors.lastname: Khademi
mesh_terms: D000284:Administration, Oral; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002443:Ceftriaxone / Q000008:administration & dosage; D020878:Device Removal; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002443:Ceftriaxone; D000583:Amikacin