Comparative effectiveness of two catheter locking solutions to reduce catheter-related bloodstream infection in hemodialysis patients.

Abstract

BACKGROUND AND OBJECTIVES:

Infection is the second leading cause of death in hemodialysis patients. Catheter-related bloodstream infection and infection-related mortality have not improved in this population over the past two decades. This study evaluated the impact of a prophylactic antibiotic lock solution on the incidence of catheter-related bloodstream infection and mortality.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

This prospective, multicenter, observational cohort study compared the effectiveness of two catheter locking solutions (gentamicin/citrate versus heparin) in 555 hemodialysis patients dialyzing with a tunneled cuffed catheter between 2008 and 2011. The groups were not mutually exclusive. Rates of catheter-related bloodstream infection and mortality hazards were compared between groups.

RESULTS:

The study population (n=555 and 1350 catheters) had a median age of 62 years (interquartile range=41-83 years), with 50% men and 71% black. There were 427 patients evaluable in the heparin period (84,326 days) and 322 patients evaluable in the antibiotic lock period (71,192 days). Catheter-related bloodstream infection in the antibiotic lock period (0.45/1000 catheter days) was 73% lower than the heparin period (1.68/1000 catheter days; P=0.001). Antibiotic lock use was associated with a decreased risk of catheter-related bloodstream infection compared with heparin (risk ratio, 0.23; 95% confidence interval, 0.13 to 0.38 after multivariate adjustment). Cox proportional hazards modeling found that antibiotic lock was associated with a reduction in mortality (hazard ratio, 0.36; 95% confidence interval, 0.22 to 0.58 in unadjusted analyses; hazard ratio, 0.32; 95% confidence interval, 0.14 to 0.75 after multivariate adjustment). The rate of gentamicin-resistant organisms decreased (0.40/1000 person-years to 0.22/1000 person-years) in the antibiotic lock period (P=0.01).

CONCLUSIONS:

The results of this study show that the use of a prophylactic, gentamicin/citrate lock was associated with a substantial reduction in catheter-related bloodstream infection and is the first to report a survival advantage of antibiotic lock in a population at high risk of infection-related morbidity and mortality.

• Authors: Carol L Moore, Anatole Besarab, Marie Ajluni, Vivek Soi, Edward L Peterson, Laura E Johnson, Marcus J Zervos, Elizabeth Adams, Jerry Yee
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 9 Issue 7 Pg. 1232-9 (Jul 2014) ISSN: 1555-905X [Electronic] United States
• PMID: 24970874 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2014 by the American Society of Nephrology.

Chemical References

• Anti-Bacterial Agents
• Anticoagulants
• Citrates
• Gentamicins
• trisodium citrate
• Heparin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Anticoagulants (therapeutic use)
• Bacteremia (diagnosis, microbiology, prevention & control)
• Catheter-Related Infections (diagnosis, microbiology, mortality, prevention & control)
• Catheterization, Central Venous (adverse effects, instrumentation, mortality)
• Catheters, Indwelling (adverse effects)
• Central Venous Catheters (adverse effects)
• Citrates (therapeutic use)
• Comparative Effectiveness Research
• Cross-Over Studies
• Female
• Gentamicins (therapeutic use)
• Heparin (therapeutic use)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Proportional Hazards Models
• Prospective Studies
• Renal Dialysis
• Risk Factors
• Time Factors
• Treatment Outcome