Tunneled Catheter-Antibiotic Lock Therapy for Prevention of Dialysis Catheter-Related Infections: A Single Center Experience

Abstract

Tunneled cuffed central vein catheters (TCC) are widely used for delivering hemodialysis (HD). Infection is the principal cause of morbidity and mortality associated with central vein catheters in patients on HD. The optimal strategy to combat TCC infec-tion is controversial. This prospective study assesses the efficacy of antibiotic-lock therapy using vancomycin and gentamycin in preventing catheter-related blood stream bacterial infection in patients on HD. A total of 86 TCC in 69 HD patients were enrolled at the time of catheter insertion for delivering HD. Patients were randomized into two groups: Group I (36 patients-39 insertions) included TCC with antibiotic-lock therapy and Group II (33 patients-47 insertions) with routine TCC management. Infection-free catheter survi-val of both groups was evaluated and compared at the end of the 18-month study period. A total of 72 TCC infections were detected with an incidence rate of 6.78 infections/1000 dialysis sessions. The rate of infection was significantly lower in Group I (4.39/1000 dialysis sessions) compared to Group II (11.69/1000 dialysis sessions), p< 0.001. The bacteremia rate, as well as rate of clinical sepsis were also significantly lower in Group I than in Group II (p< 0.001). There was no statistically significant difference in the rate of access site infec-tion in the two groups (p> 0.05). Our study suggests that antibiotic-lock therapy using a combination of vancomycin and gentamycin is useful in preventing catheter-related blood stream infection in patients on HD.