Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen
Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen
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DOI：
10.1093/ndt/gfh041
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发表时间：
2004-05-01
影响因子：
6.1
通讯作者：
Allon, M
中科院分区：
文献类型：
--
作者：
Poole, CV;Carlton, D;Allon, M
背景资料。透析导管相关菌血症的标准治疗包括全身抗生素和导管更换。我们最近报道，在透析后向导管管腔内注入抗生素锁(高浓度抗生素溶液)，结合全身抗生素，可以成功地治疗许多导管相关性菌血症，而不需要拔除导管。目前的研究评估了该方案治愈的可能性是否取决于病原体的类型。这是一项治疗导管相关菌血症的抗生素锁定方案的历史对照干预性研究。我们前瞻性地分析了透析导管相关菌血症患者使用抗生素锁定方案进行临床治愈的可能性(发热消退和阴性监测培养)。此外，对无感染的导管存活期进行了长达150天的评估，并与接受常规导管更换的患者进行了比较。总体而言，在47名患有导管相关菌血症的感染患者中，抗生素锁定方案成功33例(70%)。革兰氏阴性菌感染临床治愈的可能性为87%，表皮葡萄球菌感染临床治愈的可能性为75%，金黄色葡萄球菌感染的临床治愈可能性仅为40%(P=0.04)。使用抗生素锁定方案的患者的中位无感染导管生存期长于常规更换导管的患者(154比71天，P=0.02)。抗生素锁定方案在挽救导管的同时根除导管相关菌血症的临床成功高度依赖于细菌病原体。因此，个人透析计划的总体成功率将取决于不同细菌病原体的相对频率。
Background. The standard therapy of dialysis catheter-related bacteraemia involves both systemic antibiotics and catheter replacement. We reported recently that instillation of an antibiotic lock (highly concentrated antibiotic solution) into the catheter lumen after dialysis sessions, in conjunction with systemic antibiotics, can successfully treat many episodes of catheter-related bacteraemia without requiring catheter removal. The present study evaluated whether the likelihood of achieving a cure with this protocol depends on the type of pathogen.Methods. This was a historically controlled interventional study of an antibiotic lock protocol for the treatment of catheter-related bacteraemia. We analysed prospectively the likelihood of clinical cure (fever resolution and negative surveillance cultures) with an antibiotic lock protocol among patients with dialysis catheter-related bacteraemia. In addition, infection-free catheter survival was evaluated for up to 150 days, and compared with that observed among patients managed with routine catheter replacement.Results. Overall, the antibiotic lock protocol was successful in 33 of 47 infected patients (70%) with catheter-related bacteraemia. The likelihood of a clinical cure was 87% for Gram-negative infections, 75% for Staphylococcus epidermidis infections, and only 40% for Staphylococcus aureus infections (P = 0.04). The median infection-free catheter survival with the antibiotic lock protocol was longer than that observed among patients with routine catheter replacement (154 vs 71 days, P = 0.02).Conclusions. The clinical success of an antibiotic lock protocol in eradicating catheter-related bacteraemia while salvaging the catheter is highly dependent on the bacterial pathogen. Thus, the overall success rate in an individual dialysis programme will depend on the relative frequencies of different bacterial pathogens.