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Published on: July 13, 2019
Successful prevention of cuffed hemodialysis catheter-related infection using an antibiotic lock technique by
Ping Zhang1, Jing Yuan, Huizhen Tan
1Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
Insights
Antimicrobial lock solutions, specifically gentamicin, significantly reduce catheter-related infections (CRI) in hemodialysis patients. This study indicates gentamicin lock therapy is safe and effective for improving catheter survival rates.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Device Management
Background:
- Catheter-related infections (CRI) increase mortality and morbidity in hemodialysis patients.
- Antimicrobial lock solutions may reduce CRI, but long-term safety requires evaluation.
Purpose of the Study:
- To evaluate the efficacy and safety of gentamicin as an antimicrobial lock solution in hemodialysis patients.
- To compare CRI rates between gentamicin-heparin lock and heparin-alone lock solutions.
Main Methods:
- Randomized trial comparing gentamicin-heparin lock (G group) versus heparin-alone lock (H group) in patients with new tunneled cuffed hemodialysis catheters.
- 140 patients were enrolled.
Main Results:
- CRI rates were significantly lower in the gentamicin group (0.06/1,000 catheter-days) compared to the heparin-alone group (0.67/1,000 catheter-days).
- Patients with heparin-alone locks had a 10.54 times higher risk of CRI.
- Serum gentamicin levels remained very low, suggesting minimal systemic absorption.
Conclusions:
- Gentamicin lock solution effectively reduces CRI in hemodialysis patients.
- This therapy improves catheter survival rates.
- Gentamicin lock solution appears relatively safe for catheter-restricted use.
Background:
Catheter-related infection (CRI) is associated with increased all-cause mortality and morbidity in hemodialysis patients and may be reduced by using antimicrobial lock solutions. But the safety of long-term use of antimicrobial lock still needs to be defined.
Methods:
Patients with a new inserted permanent tunneled cuffed hemodialysis catheter were randomly assigned to an antibiotic lock solution of gentamicin (4 mg/ml) heparin (G group) or heparin alone (H group).
Results:
A total of 140 patients were enrolled in this study. CRI rates were 0.06/1,000 catheter-days for the G group versus 0.67 in the H group (p = 0.014). The risk of CRI was 10.54 higher in patients with a heparin-alone locked catheter (p = 0.025) than that with gentamicin. The serum-measured gentamicin levels were very low.
Conclusions:
Gentamicin lock solution reduces CRI and improves catheter survival rates in hemodialysis patients. It is relatively safe in strictly catheter-restricted antibiotic lock solution therapy.
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