title: The efficacy of prophylactic antibiotics administration prior to insertion of tunneled catheter in hemodialysis patients.
abstract: OBJECTIVE
  Central venous catheter (CVC)-related blood stream infection is a major cause of morbidity and mortality in patients with end-stage renal diseases. However, CVCs are quite frequently required for vascular access in hemodialysis (HD) patients. Tunneled catheters (TCs) are widely used when a catheter is needed for a long period. However, long-term catheter survival is limited by TC-related infections. The purpose of this prospective study was to assess clinical outcomes of prophylactic antibiotics administration prior to insertion of TCs in HD patients.
  
  
  METHODS
  Sixty uremic patients who required TC insertion due to vascular access failure were included in our study between April 2009 and April 2010. Patients were randomized into two groups: group I and group II. Group I received 1 g of cefazolin sodium intravenously 1 h prior to catheter insertion. Group II received equal amount of saline intravenously 1 h prior to catheter insertion. The primary end points of the study were catheter loss, hospitalization, or mortality due to catheter-related infections (CRIs). The secondary end points included exit-site infection (not requiring hospitalization), tunnel infections (not requiring catheter removal), and bacteremia.
  
  
  RESULTS
  During the follow-up period, one patient in group I and three patients in group II reached primary end point (p < 0.05). Catheter loss due to infection was higher in group II than in group I as 6 versus 3, respectively (p < 0.05). Catheter exit-site infections, which does not require hospitalization, have been considered as secondary end points and have been detected in four patients for 7 times in group I and in six patients for 10 times in group II (p < 0.05). Tunnel infection, which does not require removal of the catheter, has been detected in two patients for 3 times in group I and in five patients for 6 times in group II (p < 0.05).
  
  
  CONCLUSIONS
  The prophylactic antibiotic use prior to TC insertion significantly reduced CRIs, bacteremia, and catheter loss.
authors.affiliation: Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Huddam
authors.forename: Alper
authors.initials: A
authors.lastname: Azak
authors.forename: Gülay
authors.initials: G
authors.lastname: Koçak
authors.forename: Levent
authors.initials: L
authors.lastname: Ortabozkoyun
authors.forename: Murat
authors.initials: M
authors.lastname: Duranay
mesh_terms: D019072:Antibiotic Prophylaxis; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002437:Cefazolin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation; D016896:Treatment Outcome
chemical_list: D002437:Cefazolin