Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis.
OBJECTIVE
Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related blood stream infections (CRIs), but there are no data regarding the long-term consequences of this practice.


METHODS
Over a 4-year period, from October 1, 2002, to September 30, 2006, we initiated a gentamicin and heparin lock (GHL) protocol in 1410 chronic hemodialysis patients receiving dialysis through a tunneled catheter in eight outpatient units.


RESULTS
Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006.


CONCLUSIONS
Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.
Landry
Daniel L
DL
Baystate Medical Center, Division of Nephrology, 759 Chestnut Street, Springfield, MA 01199, USA. daniel.landry@bhs.org
Braden
Gregory L
GL
Gobeille
Stephen L
SL
Haessler
Sarah D
SD
Vaidya
Chirag K
CK
Sweet
Stephen J
SJ
D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D000925:Anticoagulants / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016009:Chi-Square Distribution; D024881:Drug Resistance, Bacterial; D004697:Endocarditis, Bacterial / Q000382:microbiology; D004867:Equipment Design; D005260:Female; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015397:Program Evaluation; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D012772:Shock, Septic / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D005839:Gentamicins; D006493:Heparin