JAC Advance Access originally published online on December 1, 2004
Journal of Antimicrobial Chemotherapy 2005 55(1):90-94; doi:10.1093/jac/dkh488
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
JAC vol.55 no.1 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved
Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial
1 Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands; 2 Internal Medicine and Infectious Diseases, UZ Gasthuisberg, Leuven; 3 Oncological Surgery, UZ Gasthuisberg, Leuven, Belgium
* Corresponding author. Tel: +31-104639222; Fax: +31-104633875; Email: b.rijnders{at}erasmusmc.nl
Objectives: The use of an antibiotic lock (AB-lock) for the treatment of catheter-related bloodstream infection (CRBSI) has been suggested, but randomized trials have never been performed.
Methods: A randomized, blinded, multicentre trial was set up to compare an AB-lock—containing vancomycin for Gram-positive or ceftazidime for Gram-negative bacteria—with placebo, in addition to parenteral AB therapy. We included only CRBSI from a long-term intravascular device (LTID) whether tunnelled or totally implanted.
Results: During 30 months, 174 patients with an LTID and bacteraemia were evaluated, of whom 85 had a CRBSI. Forty-six patients were included. Frequent reasons for exclusion were: catheter not vacant for >8–12 h/day for the AB-lock (n =10); yeast infection or mixed Gram-positive/negative infections (n =13); catheter removal preferred by the treating physician (n =7); and CRBSI <14 days after insertion or pocket/tunnel infection (n =10). Forty-four patients met the criteria for modified intention-to-treat analysis. The primary endpoint was failure to cure the CRBSI or relapse with the same strain. On study day 180 by Kaplan–Meier analysis, this occurred in 33% (seven of 21) in the AB-lock arm and in 57% (13 of 23) in the placebo arm (hazard ratio 0.55, P =0.10). A relapse with the same strain occurred in 9/23 with the placebo and 3/21 with the AB-lock (P =0.06).
Conclusion: Future studies should take into account the barriers to the use of AB-lock observed in this study. Most importantly, shorter lock dwell times and broader spectrum locks (e.g. antiseptic) should be investigated to target a larger patient population.
Keywords: infections , sepsis , treatment , ceftazidime , vancomycin
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P Anoop and M A Anjay QUESTION 2 Arch. Dis. Child., July 1, 2009; 94(7): 556 - 559. [Full Text] [PDF]
|
|
|
|
 |
|
 P B. Bookstaver, J. C Williamson, B. K. Tucker, I. I Raad, and R. J Sherertz Activity of Novel Antibiotic Lock Solutions in a Model Against Isolates of Catheter-Related Bloodstream Infections Ann. Pharmacother., February 1, 2009; 43(2): 210 - 219. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Onder, J. Chandar, A. A. Billings, N. Simon, R. Diaz, D. Francoeur, C. Abitbol, and G. Zilleruelo Comparison of Early versus Late Use of Antibiotic Locks in the Treatment of Catheter-Related Bacteremia Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1048 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Aslam, B. W. Trautner, V. Ramanathan, and R. O. Darouiche Combination of Tigecycline and N-Acetylcysteine Reduces Biofilm-Embedded Bacteria on Vascular Catheters Antimicrob. Agents Chemother., April 1, 2007; 51(4): 1556 - 1558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Raad, H. Hanna, T. Dvorak, G. Chaiban, and R. Hachem Optimal Antimicrobial Catheter Lock Solution, Using Different Combinations of Minocycline, EDTA, and 25-Percent Ethanol, Rapidly Eradicates Organisms Embedded in Biofilm Antimicrob. Agents Chemother., January 1, 2007; 51(1): 78 - 83. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Fortun, F. Grill, P. Martin-Davila, J. Blazquez, M. Tato, J. Sanchez-Corral, L. Garcia-San Miguel, and S. Moreno Treatment of long-term intravascular catheter-related bacteraemia with antibiotic-lock therapy J. Antimicrob. Chemother., October 1, 2006; 58(4): 816 - 821. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Fernandez-Hidalgo, B. Almirante, R. Calleja, I. Ruiz, A. M. Planes, D. Rodriguez, C. Pigrau, and A. Pahissa Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study J. Antimicrob. Chemother., June 1, 2006; 57(6): 1172 - 1180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Castagnola, C. Moroni, P. Gandullia, M. Oddone, C. Peri, R. Casciaro, and A. De Alessandri Catheter Lock and Systemic Infusion of Linezolid for Treatment of Persistent Broviac Catheter-Related Staphylococcal Bacteremia Antimicrob. Agents Chemother., March 1, 2006; 50(3): 1120 - 1121. [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Krzywda and D. A. Andris Twenty-five Years of Advances in Vascular Access: Bridging Research to Clinical Practice Nutr Clin Pract, December 1, 2005; 20(6): 597 - 606. [Abstract] [Full Text] [PDF]
|
|