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Comparison of tissue plasminogen activator-antibiotic locks with heparin-antibiotic locks in children with
Ali Mirza Onder1, Jayanthi Chandar, Nancy Simon
1Division of Paediatric Nephrology, Department of Paediatrics, West Virginia University, WV, USA.
Insights
Antibiotic locks (ABL) effectively treat catheter-related bacteraemia (CRB) in children on haemodialysis. Both tissue plasminogen activator (TPA)-based and heparin-based ABL solutions, with systemic antibiotics, cleared infections and potentially reduced catheter removal.
Area of Science:
- Nephrology
- Infectious Diseases
- Pediatrics
Background:
- Catheter-related bacteraemia (CRB) often stems from microbial biofilms on central venous catheters.
- Antibiotic locks (ABL) are antimicrobial solutions designed to eradicate these biofilms.
Purpose of the Study:
- To prospectively compare tissue plasminogen activator (TPA)-based and heparin-based antibiotic lock (ABL) solutions for treating CRB in pediatric haemodialysis patients.
- To evaluate the efficacy and recurrence rates of ABL treatments in managing CRB.
Main Methods:
- A prospective study involving 42 pediatric haemodialysis patients over 10 months.
- Comparison of TPA-based ABL and heparin-based ABL in conjunction with systemic antibiotics for CRB treatment.
- Monitoring of CRB incidence, symptom resolution, recurrence, and catheter survival.
Main Results:
- CRB symptoms resolved in 83% of cases within 48 hours of ABL treatment.
- No infected catheters required emergent removal due to uncontrolled CRB.
- Catheter infection-free survival was shorter with TPA-ABL versus heparin-ABL, but not statistically significant.
Conclusions:
- Both TPA-ABL and heparin-ABL, combined with systemic antibiotics, effectively clear CRB with low recurrence rates at 6 weeks.
- Early ABL application may reduce the necessity for catheter removal, preserving vascular access sites.
Background:
An accepted pathogenesis of catheter-related bacteraemia (CRB) is the seeding of microorganisms from the intraluminal biofilm of central venous catheters. Antibiotic locks (ABL) are solutions containing high concentrations of antimicrobials with or without anticoagulants that aim to destroy the biofilm.
Methods:
In this study, two different ABL solutions, tissue plasminogen activator (TPA)-based and heparin-based ABL, used in conjunction with systemic antibiotics, were prospectively compared in the treatment of CRB.
Results:
A total of 42 children on chronic haemodialysis with 11,016 catheter-days were observed for signs and symptoms of CRB over a period of 10 months. Twenty-four CRBs were diagnosed in 18 children (2.2 CRB/1000 catheter-days) and were treated with the protocol. Symptoms of CRB resolved in 83% within 48 h of treatment. None of the infected catheters required early emergent exchange or removal for poorly controlled CRB. Six children had recurrence of CRB within 6 weeks, of which four required catheter exchange. There was no specific microorganism or type of CRB that predisposed to higher recurrence rates. The mean infection-free survival of the catheters following TPA-ABL treatment was shorter than that following heparin-ABL treatment, but was not statistically significant by the log-rank test (126.8 +/- 81.6 days versus 154.5 +/- 70.4 days).
Conclusion:
Both TPA-ABL and heparin-ABL used in conjunction with systemic antibiotics can effectively clear CRB without significant late recurrence at 6 weeks. Early use of ABL for management of CRB can potentially decrease the need for catheter removal, thus salvaging vascular access sites.
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