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Published on: July 13, 2019
Prophylaxis with gentamicin locking of chronic tunnelled central venous catheters does not cause bacterial resistance
J Fernández-Gallego1, M Martín, E Gutiérrez
1Nephrology Department, Carlos Haya Hospital, Málaga, Spain. juan.fernandezgallego.sspa@juntadeandalucia.es
Insights
Gentamicin catheter locking in hemodialysis patients prevents bacterial resistance and ototoxicity. This 7-year study found low infection rates and no adverse effects, suggesting a safe and effective prophylaxis method.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Chronic haemodialysis patients with central venous catheters are at risk of bacterial infections.
- Gentamicin catheter locking is a prophylaxis strategy to reduce these infections and associated mortality.
Purpose of the Study:
- To evaluate the development of bacterial resistance to gentamicin in pathogens.
- To assess the incidence of clinical ototoxicity in patients receiving gentamicin prophylaxis.
Main Methods:
- A 7-year prospective observational study of 101 chronic haemodialysis patients.
- Universal asepsis protocol with intraluminal gentamicin (5mg/branch) + heparin locking post-dialysis.
- Monitoring of gentamicin trough blood levels and diagnosis of bacteraemia based on standard criteria.
Main Results:
- No bacterial resistance to gentamicin was observed in pathogens typically sensitive to the antibiotic.
- No cases of clinical ototoxicity were reported among the study participants.
- Low rates of hospitalization (3%), bacteraemia (0.11/catheter/1000 days), infectious mortality (1%), and catheter withdrawal (2%) due to bacteraemia were recorded.
Conclusions:
- Intraluminal gentamicin locking prophylaxis is safe and does not induce bacterial resistance or ototoxicity.
- The low dose of gentamicin used in this protocol may contribute to the absence of resistance and ototoxicity.
- This prophylaxis method appears effective in reducing catheter-related infections in chronic haemodialysis patients.
Introduction:
Prophylaxis with gentamicin locking of chronic tunnelled central venous catheter branches in chronic haemodialysis patients reduces bacterial infections and morbidity and mortality associated with catheter bacteraemia.
Aim:
We undertook a 7-year, prospective, observational study involving 101 patients on chronic haemodialysis with catheters treated with prophylaxis to evaluate the appearance of bacterial resistance to the antibiotic in pathogens usually sensitive to its action.
Material And Methods:
A protocol of universal asepsis in catheter management. Postdialysis intraluminal locking of the branches with gentamicin at 5mg/branch + 1% heparin sodium, monitoring trough levels in the blood and modifying the dose according to the established protocol. The diagnosis of bacteraemia was based on usual criteria. The main study variables were: Diagnosis by the bacteriology department of bacterial resistance in pathogens sensitive to gentamicin. Diagnosis of clinical ototoxicity. Secondary variables were: Patients hospitalised/bacteraemia; number of bacteraemia/catheter/1000 days; infectious mortality; and catheter withdrawal/bacteraemia. Pathogens found in blood culture.
Main Variables:
We found no resistance of pathogens usually sensitive to the antibiotic or clinical ototoxicity. The mean number of months each patient remained in the study was 23 (1-84). Secondary variables: Three patients (3%) were hospitalised due to bacteraemia; number of bacteraemias: 8; number of bacteraemia/catheter/1000 days: 0.11; infectious mortality per bacteraemia: 1 patient (1%); catheter withdrawal due to bacteraemia: 2 (2%). No patients were diagnosed with endocarditis or spondylodiscitis. The mean trough level of gentamicin in each patient during the study was 0.17µg/ml (0.05-0.31); the mean intraluminal gentamicin locking dose per branch was 3mg (2-5), equivalent to 1.1-1.7mg/ml/branch.
Conclusions:
This 7-year, prospective observational study of 101 patients on chronic haemodialysis with tunnelled central venous catheters showed: 1) Prophylaxis with intraluminal gentamicin locking of the catheter branches does not cause bacterial resistance in pathogens sensitive to its action. 2) No clinical ototoxicity was seen. 3) The lack of resistance and ototoxicity may be influenced by the gentamicin prophylaxis dose used, which was much lower than in other studies.
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