Original InvestigationDialysisTreatment of Dialysis Catheter–Related Enterococcus Bacteremia With an Antibiotic Lock: A Quality Improvement Report
Section snippets
Setting
The University of Alabama at Birmingham (UAB) provides medical care for approximately 450 hemodialysis patients under the supervision of 10 full-time clinical nephrologists. About 25% of these patients are catheter dependent at any given time. More than 95% of all hospitalizations of our dialysis patients occur at UAB Hospital, allowing for comprehensive follow-up of any complications. Two full-time access coordinators schedule all access procedures and maintain a prospective computerized
Situation Analysis
All dialysis patients with CRB were treated by using a uniform protocol with objective outcome measures. Use of a consistent protocol and prospective documentation of outcomes permitted us to perform a formal analysis of the success and complication rates in the subset of patients with Enterococcus bacteremia.
Outcomes
Of 64 patients with Enterococcus CRB treated with an antibiotic lock, fever persisted in 16% of patients, and their infected catheters were removed promptly (Fig 1). In an additional 23%
Discussion
The present study found a relatively high success rate (61%) of vancomycin lock treatment in salvaging the infected catheter in a large population of hemodialysis patients with Enterococcus CRB. This cure rate was less than that previously observed at our institution for gram-negative CRB (87%) and S epidermidis CRB (75%), but greater than that for S aureus CRB (41%).6, 8 The reason for the treatment failures cannot be determined from the present study. Two potential explanations are a biofilm
Acknowledgements
Portions of this report were presented in abstract form at the Clinical Meeting of the National Kidney Foundation; April 2 to 6, 2008, Dallas, TX.
Support: This research was supported in part by Grant No. 1 K24 DK59818-01 from the National Institute of Diabetes and Digestive and Kidney Diseases to Dr Allon.
Financial Disclosure: None.
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Cited by (25)
Spanish Clinical Guidelines on Vascular Access for Haemodialysis
2017, NefrologiaHemodialysis vascular access complications: Recognition and management
2014, Hospital Medicine ClinicsCitation Excerpt :The success rate varies considerably by organism, with 87% cure rate for gram-negative infections, 75% for Staphylococcus epidermidis infections, and 60% for Enterococcus. The success rate of salvage in the case of S aureus is low (∼40%) and therefore should be considered only in problematic cases.56–58 What can be done to reduce incidence of infection?
Optimizing future treatment of enterococcal infections: Attacking the biofilm?
2012, Trends in MicrobiologyCitation Excerpt :Of these treatments, only silver [61] and antimicrobial lock therapy were found to be effective against enterococcal infections in the clinic. Vancomycin–heparin lock therapy seems to be a promising method for preventing bacterial growth associated with dialysis catheters; nevertheless antibiofilm action in this observational study was not supported by imaging, and the intervention was not compared to standards of care [62]. Although C-MP-P (sodium citrate, methylene blue, methylparaben, and propylparaben) lock solution for hemodialysis catheters proved to be effective in reducing catheter-related bloodstream infections, this multi-center trial with relatively small numbers of infections was not powered to detect a significant reduction in enterococcal infections [63].
Treatment Guidelines for Dialysis Catheter-Related Bacteremia: An Update
2009, American Journal of Kidney DiseasesRisk of infections related to endovascular catheters and cardiac implantable devices in hemodialysis patients
2024, Journal of Vascular Access
Originally published online as doi:10.1053/j.ajkd.2008.06.033 on October 13, 2008.