Effectiveness of Antimicrobial Lock Therapy (ALT) for Catheter-Related Bacteremia (CRB).

B. ALMIRANTE, N. FERNANDEZ-HIDALGO, R. CALLEJA, I. RUIZ, A.M. PLANES, D. RODRIGUEZ, C. PIGRAU, A. PAHISSA

Author address: 

Hospital Vall d'Hebron, Barcelona, Spain.

Abstract: 

Background: CRB usually requires systemic antibiotic therapy and catheter removal. The aim of this study was to evaluate the effectiveness of combining a ALT with systemic therapy to treat CRB in patients with long-term central venous catheter (CVC). Methods: Diagnosis of CRB was made when the same organism was isolated from blood cultures taken simultaneously from the catheter and venopuncture, with a catheter/peripheral CFU/mL ratio grater or equal to 5. Antibiotic systemic treatment was combined with ALT from the first day using vancomycin (2 mg/mL) for grampositive microorganisms, ciprofloxacin (2 mg/mL) for gramnegative rods, and amphotericin B (4 mg/mL) for Candida spp. The effectiveness of the therapy was evaluated by clinical and microbiological measures. Cure was defined by both negative blood cultures without removal catheter after complete antimicrobial therapy. Results: 51 episodes of CRB in 43 patients were analyzed. CVC location was: jugular (41), subclavian (8), and femoral (2) veins. CVC were used for: chemotherapy in 26 episodes, haemodialysis in 16, and total parenteral nutrition in 9. Median length of permanence of CVC until the CRB was 90 days (4-1050 days). Microorganisms isolated were: coagulase negative Staphylococci (CNS) (20), S. aureus (17), E. coli (7), Candida spp (2), and miscellaneous (5). Cure was observed in 42 episodes (82.4%). Nine therapeutic failures were detected: S. aureus in 8 (7 for persistent fever, and 1 for septic shock), and CNS 1 (tunnel infection after antimicrobial therapy initiation). The median length of catheter follow-up in patients with successful therapy was 134 days (10-1885). Conclusions: ALT combined with conventional systemic antibiotic seems to be an effective treatment in CRB.
2003

abstract No: 

K-145

Full conference title: 

43rd Interscience Conference on Antimicrobial Agents
    • ICAAC 43rd