scholarly journals Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

2018 ◽  
Vol 8 (2) ◽  
pp. 121-129 ◽  
Author(s):  
Wasim S. El Nekidy ◽  
Derrick Soong ◽  
Albert Kadri ◽  
Osama Tabbara ◽  
Amina Ibrahim ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Case Series ◽  
Blood Stream ◽  
Hemodialysis Patients ◽  
Vascular Trauma ◽  
Central Vein ◽  
Hemodialysis Catheter ◽  
Lock Solution ◽  
Antibiotic Lock ◽  
Systemic Antibiotics

Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.

A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients

2021 ◽  
Vol 30 (14) ◽  
pp. S24-S32
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Adverse Events ◽  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Technical Problems ◽  
Hemodialysis Catheter ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

HIGHLIGHTS 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis Background: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. Methods: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. Results: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. Conclusions: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.

scholarly journals Frequency and Microbiological Profile of Catheter-Related Infections in Hemodialysis Patients Receiving Gentamicin as Antimicrobial Lock Therapy for Prophylaxis

2021 ◽  
Vol 4 (03) ◽  
Author(s):  
Sumbal Nasir Mahmood ◽  
Sabaa Asif ◽  
Muhammad Amim Anwar ◽  
Osama Kunwer Naveed
Keyword(s):  
Blood Culture ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Cross Sectional Study ◽  
Immunosuppressive Drugs ◽  
Hemodialysis Patients ◽  
Exit Site ◽  
Cross Sectional ◽  
Exit Site Infection ◽  
Antibiotic Lock

Antibiotic lock solution (ALS) in the lumen of catheter is a mean to decrease the possibility of catheter related blood stream infection (CRBSI). We conducted this study using Gentamicin as ALS to observe the frequency of catheter related infections (CRI) including CRBSI and exit site infection in this hemodialysis patients being dialyzed through tunneled and temporary hemodialysis catheters. Methods This descriptive, cross sectional study was conducted at Dr. Ziauddin Hospital, North Campus between January 2017- December 2017. Symptomatic patients for CRBSI were included in this study. Blood culture from the catheter ports and periphery and exit site swab if pus visible were sent for culture sensitivity.  Results Total 138 patients of either gender with age more than 18 years to less than 80 years were evaluated. 44.9% were male and mean age of patients was 58.79±14.05 years. 70.3% patients were diabetic for 15.61±4.61 years and 11.6% were using immunosuppressive drugs. The overall mean catheter duration was 22.27±14.39 days and mean hemodialysis duration was 25.32±44.31 weeks. Tunneled catheter was placed in 40.6% and 46.4% had femoral temporary catheters. Blood culture was done for 51 cases and 21.5% were positive. Tip culture was positive in 33.3% patients. In our study, 23.18% patients were found to have catheter related infections, out of which 61.5% were found with gentamicin resistance including colonization. Conclusion We report a high frequency of catheter related infections despite using ALS as prophylaxis, with predominant organisms being gram positives and a high incidence of gentamycin resistance.

scholarly journals Hemodialysis catheter related blood stream infections

2018 ◽  
Vol 6 (2) ◽  
pp. 562
Author(s):  
Tanuja Nambakam Subramanyam ◽  
Girish P. Vakrani
Keyword(s):  
Blood Sample ◽  
Early Result ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Hemodialysis Patients ◽  
Morbidity And Mortality ◽  
Catheter Removal ◽  
Exit Site ◽  
Hemodialysis Catheter ◽  
Catheter Tip

Background: Hemodialysis catheter related blood stream infection (CRBSI) is common cause for sepsis in hemodialysis patients with high morbidity and mortality. It has to be diagnosed promptly for early treatment to avoid serious complications including catheter removal. This prospective study was undertaken to study clinical features, to validate use of cultures drawn from different sites for diagnosis and management of hemodialysis catheter related blood stream infection (CRBSI). As there is paucity of data regarding CRBSI, hence the study was undertaken.Methods: All hemodialysis patients with CRBSI between October 2016 to October 2017 were included. Variables like different catheter position, blood cultures collected from peripheral vein, both catheter hubs, catheter exit site swab, and catheter tip cultures were analyzed with respect to time to culture positivity, microbes and its management were analyzed.Results: Mean duration of hemodialysis catheter inside patient was 24days, most common risk factor for CRBSI was diabetes mellitus (58%) followed by surgery (50%), previous dialysis catheterization within preceding 2months (33%). 30% patients had history of guide wire exchange of catheters previously, most had temporary catheter (88%), most common site of catheter was right internal jugular vein (58%). Cultures showed gram positive organisms in 63%. It was found that same monomicrobial growth was noted in most cultures stating less chances of contamination. Exit site, catheter tip samples and blood sample from catheter’s venous hub yielded early result. It was found that same monomicrobial growth was noted in most cultures stating less chances of contamination. Among complications, 8% had endocarditis, 61% had catheter removal. Average hospital stay was 9days. Deferve scence was noted upon antibiotic therapy and catheter removal in most cases. Death was noted in 8% due to sepsis.Conclusions: CRBSI are major cause of admissions, morbidity and mortality in hemodialysis patients on catheters. Gram positive organisms were commonest pathogens causing CRBSI. Exit site, catheter tip samples and blood sample from catheter’s venous hub yielded early result. Peripheral blood sampling for culture diagnosing was unnecessary. Most requires 2-6weeks systemic antibiotics and catheter removal especially if persistent fever and systemic complications are present.

scholarly journals Sodium bicarbonate catheter lock solution reduces hemodialysis catheter loss due to catheter-related thrombosis and blood stream infection: an open-label clinical trial

2019 ◽  
Vol 34 (10) ◽  
pp. 1739-1745 ◽  
Author(s):  
Adel S El-Hennawy ◽  
Elena Frolova ◽  
Wesley A Romney
Keyword(s):  
Sodium Bicarbonate ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Blood Stream ◽  
Open Label ◽  
Hemodialysis Catheter ◽  
Novel Approach ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Thrombosis

AbstractBackgroundThere is no ideal lock solution that prevents hemodialysis (HD) catheter loss due to catheter-related thrombosis (CRT) and catheter-related bloodstream infection (CRBSI). Catheter loss is associated with increased hospitalization and high inpatient costs. Sodium bicarbonate (NaHCO3) demonstrates anti-infective and anticoagulation properties with a good safety profile, making it an ideal lock solution development target.The objective of this study was to determine the safety and efficacy of using sodium bicarbonate catheter lock solution (SBCLS) as a means of preventing HD catheter loss due to CRT and CRBSI.MethodsThe study took place in a community hospital in Brooklyn, NY, USA. All admitted patients ≥18 years of age who needed HD treatment through CVC were included in the study. 451 patients included in the study were provided SBCLS or NSCLS post-dialysis. Catheter loss due to CRT or CRBSI was evaluated over a period of 546 days.ResultsA total of 452 patients met the criteria; 1 outlier was excluded, 226 were in the NSCLS group and 225 were in the SBCLS group. There were no significant differences between groups in comorbidities at the outset. The NSCLS group had CRT and CRBSI rates of 4.1 and 2.6/1000 catheter days (CD), respectively, compared with 0.17/1000 CD for both outcomes in the SBCLS group. SBCLS patients had a significantly reduced catheter loss rate due to CRT (P < 0.0001) and CRBSI (P = 0.0004). NSCLS patients had higher odds of losing their catheter due to CRT {odds ratio [OR] 26.6 [95% confidence interval (CI) 3.57–198.52]} and CRBSI [OR 15.9 (95% CI 2.09–121.61)] during the study period.ConclusionThe novel approach of using SBCLS was found to be safe and was statistically superior to normal saline in preventing HD catheter loss due to CRT and CRBSI. NaHCO3 solution is inexpensive, readily available in various settings and holds the potential to decrease hospitalization, length of stay and dialysis-related costs.Trial registrationMaimonides Medical Center Investigational Review Board, Study IRB 2015-06-25-CIH. ClinicalTrials.gov identifier: NCT03627884.

Management of hemodialysis catheter related bacteremia (CRB) with an adjunctive antibiotic lock solution

2001 ◽  
Vol 37 (4) ◽  
pp. A21
Author(s):  
Zipporah Krishnasami ◽  
Donna Carlton ◽  
Lisa Bimbo ◽  
Michael Allon
Keyword(s):  
Hemodialysis Catheter ◽  
Lock Solution ◽  
Antibiotic Lock

scholarly journals Hemodialysis Catheter-related Infections: Incidence, Microbiology and Outcome 5 years of Dubai Hospital Experience

2021 ◽  
Vol 2 (3) ◽  
pp. 111-115
Author(s):  
Hussein Yousif Salem ◽  
Maseer Ahmed ◽  
Kashif Gulzar ◽  
Fakhriya Alalawi ◽  
Amna Alhadari
Keyword(s):  
Vascular Access ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Klebsiella Pneumonia ◽  
Average Hospital ◽  
Gram Negative ◽  
Hemodialysis Catheter ◽  
Extended Spectrum Beta Lactamase

Background: The central venous catheters (CVC) has recently become a worldwide commonest technique for vascular access, however; prone to infection and associated with other complications more than other vascular access techniques, such as fistula or graft. Objective: To investigate the incidence, the types of micro-organism, the most sensitive and suitable antibiotics, the outcomes associated with CVC infection in chronic hemodialysis patients treated through tunneled CVC.in a single-center population. Methods: The records of hemodialysis patients from January 2012 to December 2016 were reviewed. Patients above 14 years of age, on hemodialysis via a permanent tunneled catheter at any time of the mentioned period, were included. The rate of CRBSI (Catheter-Related Blood Stream Infections) was calculated as density of incidence and reported per 1000 catheter days. Patient mortality was recorded. Results: In 5 years, a total of 73 episodes of CRBSI in 49 hemodialysis patients were recorded. 59.2% were male with a mean age of 53.57 years. 40.8% had end-stage kidney disease secondary to diabetic nephropathy. In all, 67.3% episodes grew Gram-positive isolates, among those staphylococci epidermidis (26.4%, n=19) and staphylococci aureus (25%, n=18) were the most common organism, whereas Klebsiella pneumonia (8.3%, n=6), Enterobacter cloacae (8.3%, n=6), pseudomonas aeruginosa (5.5%, n=4) and E.coli (5.5%, n=4) were the most common Gram-negative isolates. A total of 6 isolates were multidrug-resistant, which includes Klebsiella pneumonia, Citrobacter, and E. coli. Only 1 out of 18 staphylococci aureus cases were methicillin-resistant and 21% (n=6) of Gram-negative isolates were Extended-spectrum beta-lactamase (ESBL) producing organisms. The average hospital stay was 9 days (2-30 days). The hemodialysis catheter was removed for 19 (38.77%) patients and 4 (8.1%) patients expired due to septic shock despite catheter removal and being on appropriate antibiotics. Conclusion: The mainstay to reduce CRBSI would be ideal to avoid catheters or decrease the duration of catheters. This can be achieved through more aggressive counseling and fast-track protocols for AV Fistulae creation at the pre-dialysis stage.

MO786HEPARIN VERSUS SODIUM BICARBONATE CATHETER LOCK SOLUTION: AN ALTERNATIVE LOCK HEMODIALYSIS CATHETER?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francesca Partipilo ◽  
Francesco Detomaso ◽  
Stefania Pietanza ◽  
Giuseppe Gernone
Keyword(s):  
Sodium Bicarbonate ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Exit Site Infection ◽  
Hemodialysis Catheter ◽  
Sodium Heparin ◽  
Lock Solution ◽  
Catheter Lock ◽  
The Many ◽  
Wbc Count

Abstract Background and Aims Infections and thrombosis of central venous catheter (CVC) in hemodialysis patients are the major causes of catheter loss resulting in hospitalization and increased costs. Interdyalitic catheter lock solutions, usually heparin, avoid these complications. Among the many, sodium bicarbonate has been proved as effective and safe catheter lock solution due to its antimicrobial and antithrombotic properties. The aim of this study was to compare the efficacy of two different CVC lock solution: sodium heparin versus sodium bicarbonate, to prevent catheter–related thrombosis and infection in hemodialysis patients Method They were enrolled, in a 12 months case-control study, 17 hemodialysis patients with tunneled hig-flux CVC (femoral or internal jugular). Each patient was evaluated in its common treatment for CVC dysfunction (Qb, CVC that works in reverse branches during the hemodialysis session, use of urokinase or extra lock with sodium heparin or 4% citrate) and infection (WBC count, C reactive protein -CRP, bloodstream culture, exit-site infection -ESI) during standard sodium heparin CVC lock solution (hep-lock), for the first 6 months, and then, during sodium bicarbonate lock solution (10 mEq/10 ml, bic-lock) for following 6 months. aPTT, PLT, Hct and albumin are also montly evaluated. Type and anticoagulant dose during hemodialysis sessions were unchanged over the study as well as any antiplatelet/anticogulant home therapy. Results Fifteen patients on 17 completed the study and the main results are reported in table 1. There were no significant differences between patients on demographics and number of catheter days treatments for both study periods. The blood flow was similar in either study phases and stable during the hemodialysis sessions (Qb 225±13 ml/m’ at 2-hours vs 225±15 ml/min at start of dialysis), even the use of reverse branches was similar. Hep-lock showed a lower usage of extra lock drug in comparison with Bic-lock (0,4% vs 3,1%, p&lt;0,05), data confirmed also for Urokinase (1,9% vs 3,4%, p=0,274). None bloodstream are registred while ESI and WBC count show no significant differences between two study periods. No HD catheter was loss during the study due to thrombosis or infection. Finally, Hct, CRP and Albumin was found slightly lower on Bic-lock phase. Conclusion There is no CVC ideal lock solution and although sodium bicarbonate is inexpensive and readily avalaible our data shows better CVC performances with sodium heparin.

Sign in / Sign up

Export Citation Format

Share Document