Prevention of uncuffed hemodialysis catheter-related bacteremia using an antibiotic lock technique: A prospective, randomized clinical trial

S. H. Kim, K. I. Song, J. W. Chang, S. B. Kim, S. A. Sung, Sang Kyung Jo, Won Yong Cho, H. K. Kim

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

As a result of the high rate of infection, the NKF-K/DOQI guidelines recommended that an uncuffed catheter (UC) should not be used for longer than 3 weeks. However, the findings of the Dialysis Outcomes and Practice Patterns Study recognized that 48% of new hemodialysis patients in the US and 75% in Europe used UC for temporary access during arteriovenous fistula or graft maturation. The antibiotic lock technique (ALT) has been recommended to prevent catheter-related bacteremia (CRB). Here, we prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 120 new hemodialysis patients requiring a temporary catheter while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a UC were randomly assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1000 U/ml) as a catheter lock solution during the interdialytic period. The end point of the trial was CRB. CRB developed in seven (11.7%) patients in the no-antibiotic group (Staphylococcus aureus, two; Staphylococcus epidermidis, five) whereas only one patient in the antibiotic group had S. aureus bacteremia. CRB rates per 1000 catheter-days were 0.44 in the antibiotic group versus 3.12 in the no-antibiotic group (P = 0.031). Kaplan-Meier analysis also showed that mean CRB-free catheter survival of 59 days (95% CI, 58-61 days) in the antibiotic group was greater than that in the no-antibiotic group (55 days; 95% CI, 50-59 days). The results suggest that ALT may be a beneficial means of reducing the CRB rate in hemodialysis patients with UC.

Original languageEnglish
Pages (from-to)161-164
Number of pages4
JournalKidney International
Volume69
Issue number1
DOIs
Publication statusPublished - 2006 Jan 1

Fingerprint

Bacteremia
Renal Dialysis
Catheters
Randomized Controlled Trials
Anti-Bacterial Agents
Heparin
Arteriovenous Fistula
Staphylococcus aureus
Transplants
Cefazolin
Staphylococcus epidermidis
Kaplan-Meier Estimate
Gentamicins
Dialysis

Keywords

  • Antibiotic lock technique
  • Catheter-related bacteremia
  • Uncuffed catheter

ASJC Scopus subject areas

  • Nephrology

Cite this

Prevention of uncuffed hemodialysis catheter-related bacteremia using an antibiotic lock technique : A prospective, randomized clinical trial. / Kim, S. H.; Song, K. I.; Chang, J. W.; Kim, S. B.; Sung, S. A.; Jo, Sang Kyung; Cho, Won Yong; Kim, H. K.

In: Kidney International, Vol. 69, No. 1, 01.01.2006, p. 161-164.

Research output: Contribution to journalArticle

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abstract = "As a result of the high rate of infection, the NKF-K/DOQI guidelines recommended that an uncuffed catheter (UC) should not be used for longer than 3 weeks. However, the findings of the Dialysis Outcomes and Practice Patterns Study recognized that 48{\%} of new hemodialysis patients in the US and 75{\%} in Europe used UC for temporary access during arteriovenous fistula or graft maturation. The antibiotic lock technique (ALT) has been recommended to prevent catheter-related bacteremia (CRB). Here, we prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 120 new hemodialysis patients requiring a temporary catheter while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a UC were randomly assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1000 U/ml) as a catheter lock solution during the interdialytic period. The end point of the trial was CRB. CRB developed in seven (11.7{\%}) patients in the no-antibiotic group (Staphylococcus aureus, two; Staphylococcus epidermidis, five) whereas only one patient in the antibiotic group had S. aureus bacteremia. CRB rates per 1000 catheter-days were 0.44 in the antibiotic group versus 3.12 in the no-antibiotic group (P = 0.031). Kaplan-Meier analysis also showed that mean CRB-free catheter survival of 59 days (95{\%} CI, 58-61 days) in the antibiotic group was greater than that in the no-antibiotic group (55 days; 95{\%} CI, 50-59 days). The results suggest that ALT may be a beneficial means of reducing the CRB rate in hemodialysis patients with UC.",
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