Usefulness of anti-infective lock solutions for catheter-related bloodstream infections

Central venous catheters are commonly used for the administration of medications in both the inpatient and outpatient settings, but their use carries the risk of developing catheter-related bloodstream infections, increasing morbidity and mortality. Guidelines from the Infectious Diseases Society of America include use of antibiotic lock solutions as a therapeutic option for intraluminal infections when the device is difficult to remove, but these lock solutions are not indicated routinely for the prophylaxis of catheter-related bloodstream infections. Because catheter removal is not always possible in patients who require chronic catheterization or who have multiple catheters, antibiotic lock therapy can be utilized with the goal of sparing removal of the catheter while sterilizing the lumen. The use of an antibiotic lock solution is an appealing option for localized infections because it is easy to use, is associated with a low cost, and is usually without systemic side effects if the catheter remains closed. Patients with long-term or short-term catheters with no signs of exit-site or tunnel infection for whom salvage is the goal may benefit from this technique when treated with systemic antibiotics. Consider antibiotic lock therapy only in uncomplicated infections, typically nontunneled catheter or port infections with coagulase-negative staphylococci or gram-negative bacilli. Generally, a short-term regimen of 7 to 14 days is recommended. Several studies have supported antimicrobial lock therapy with vancomycin, gentamicin, cefazolin, or ethanol. Antibiotic locks have the potential to positively impact mortality and cost savings. A protocol at the Mount Sinai Medical Center is in development.