Background Data on antibiotic lock catheter therapy (ALCT) with high heparin doses in haemodialysis is described in many guidelines. However, the bibliography is heterogeneous and unclear.
Purpose To develop an ALCT protocol for the treatment of catheter related bloodstream infections (CRBSI) which ensures stability and compatibility of different antibiotic concentrations with high heparin doses, and to analyse the results of its implementation, comparing clinical outcomes before and after the start up.
Material and methods A bibliographic search was performed in Pubmed using antibiotic lock, catheter and haemodialysis as the main terms. Mixings with higher heparin and antibiotic doses with at least one reference that guaranteed its stability were selected for testing to ensure physical compatibility. The forming or absence of a precipitate was checked by 2 different observers in a total of 70 solutions following several elaboration techniques. Patients fitted with a catheter during the 6 month period before (n=43) and after (n=47) implementation of the ALCT protocol were monitored to register CRBSI and number of catheter removals.
Results Only 10 solutions were selected due to adequate compatibility, as shown in the table.
After protocol development, 14 patients were affected with 16 CRBSI (64±16 years; half-life of the catheter 22±16 months). 9 ALCT solutions for empiric treatment were administrated: 7 with vancomycin in patients fitted with a jugular catheter and 2 with vancomycin and gentamicin in patients fitted with a femoral catheter. 7 ALCT solutions for confirmed infection were prepared: 2 ceftazidime for E coli, 2 ciprofloxacin for S epidermidis and E aerogenus, 1 vancomycin for MRSA and 2 amphotericin B for C parapsilosis. ALCT was successful in 15 CRBSI. 1 patient with Candida (2.12% of 47 patients) required removal of the catheter due to a severe infection and delayed treatment. Before implementation of ALCT, 2 patients (4.65%) required removal of the catheter.
Conclusion The validation and implementation of the ALCT protocol ensures preparation of safe and stable solutions with the final purpose of optimising clinical outcomes.
No conflict of interest
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