American Journal of Kidney Diseases
Volume 53, Issue 3 , Pages 492-502 , March 2009

Effect of Antimicrobial Locks for Tunneled Hemodialysis Catheters on Bloodstream Infection and Bacterial Resistance: A Quality Improvement Report

  • Saib A. Abbas, MRCP

      Affiliations

    • Department of Renal Medicine, Middlemore Hospital, Counties-Manukau District Health Board, Manukau, New Zealand
  • ,
  • Imad A. Haloob, FRACP

      Affiliations

    • Department of Renal Medicine, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
  • ,
  • Susan L. Taylor, FRCPA

      Affiliations

    • Department of Clinical Microbiology, Middlemore Hospital, Counties-Manukau District Health Board, Manukau, New Zealand
  • ,
  • Elizabeth M. Curry, MBChB

      Affiliations

    • Department of Renal Medicine, Middlemore Hospital, Counties-Manukau District Health Board, Manukau, New Zealand
  • ,
  • Bruce B. King, FRACP

      Affiliations

    • Department of Renal Medicine, Nelson Hospital, Nelson Marlborough District Health Board, Nelson, New Zealand
  • ,
  • Walter M. Van der Merwe, FRACP

      Affiliations

    • Department of Renal Medicine, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand
  • ,
  • Mark R. Marshall, FRACP

      Affiliations

    • Department of Renal Medicine, Middlemore Hospital, Counties-Manukau District Health Board, Manukau, New Zealand
    • Corresponding Author InformationAddress correspondence to Mark R. Marshall, FRACP, Department of Renal Medicine, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand

Received 5 April 2008 ,Accepted 18 September 2008.

References 

  1. Burr R, Marszalek J, Saul M, Shields M, Aslam N. The cost of vascular access infections: Three years experience from a single outpatient dialysis center. Hemodial Int. 2003;7:73–104
  2. Liu JW, Su YK, Liu CF, Chen JB. Nosocomial blood-stream infection in patients with end-stage renal disease: Excess length of hospital stay, extra cost and attributable mortality. J Hosp Infect. 2002;50:224–227
  3. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: A propensity score analysis. J Am Soc Nephrol. 2004;15:477–486
  4. Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among hemodialysis patients. Kidney Int. 2002;62:620–626
  5. Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: The USRDS Wave 2 Study. Kidney Int. 2005;68:311–318
  6. Schwab SJ, Beathard G. The hemodialysis catheter conundrum: Hate living with them, but can't live without them. Kidney Int. 1999;56:1–17
  7. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Morbid Mortal Wkly Rep 51(No. RR-10). 2002;28:
  8. Lok CE. Avoiding trouble down the line: The management and prevention of hemodialysis catheter-related infections. Adv Chronic Kidney Dis. 2006;13:225–244
  9. Manierski C, Besarab A. Antimicrobial locks: Putting the lock on catheter infections. Adv Chronic Kidney Dis. 2006;13:245–258
  10. Bleyer AJ. Use of antimicrobial catheter lock solutions to prevent catheter-related bacteremia. Clin J Am Soc Nephrol. 2007;2:1073–1078
  11. Dogra G, Herson H, Hutchison B, et al. Prevention of tunnelled hemodialysis catheter related infections using catheter-restricted filling with gentamicin and citrate: A randomized controlled study. J Am Soc Nephrol. 2002;13:2133–2139
  12. Sodemann K, Polaschegg H, Feldmer B. Two years' experience with Dialock and CLS (a new antimicrobial lock solution). Blood Purif. 2001;19:251–254
  13. Vercaigne LM, Sitar DS, Penner SB, Bernstein K, Wang GQ, Burczynski FJ. Antibiotic-heparin lock: In vitro antibiotic stability combined with heparin in a central venous catheter. Pharmacotherapy. 2000;20:394–399
  14. Riley B. Incompatibilities in intravenous solutions. J Hosp Pharm. 1970;28:228–240
  15. Trissel L. Handbook on Injectable Drugs. Bethesda, MD: American Society of Health-System Pharmacists; 2003;
  16. Bastani B, Amin K, Herr A. Prolonged stability of stored vancomycin, gentamicin, and heparin for use in the antibiotic-lock technique. ASAIO J. 2005;51:761–763
  17. Regamey C, Schaberg D, Kirby WM. Inhibitory effect of heparin on gentamicin concentrations in blood. Antimicrob Agents Chemother. 1972;1:329–332
  18. Krishnasami Z, Carlton D, Bimbo L, et al. Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution. Kidney Int. 2002;61:1136–1142
  19. Saxena A, Panhotra B, Naguib M. Sudden irreversible sensory-neural hearing loss in a patient with diabetes receiving amikacin as an antibiotic-heparin lock. Pharmacotherapy. 2002;22:105–108
  20. Dogra G, White L, Herson H, et al. Prevention of tunneled hemodialysis catheter-related infections using low concentration gentamicin and citrate. Nephrology (Carlton). 2004;9(suppl 1):S13A;abstr
  21. Kim SH, Song KI, Chang JW, et al. Prevention of uncuffed hemodialysis catheter-related bacteremia using an antibiotic lock technique: A prospective, randomized clinical trial. Kidney Int. 2006;69:161–164
  22. McIntyre CW, Hulme LJ, Taal M, Fluck RJ. Locking of tunneled hemodialysis catheters with gentamicin and heparin. Kidney Int. 2004;66:801–805
  23. Feely T, Copley A, Bleyer AJ. Catheter lock solutions to prevent bloodstream infections in high-risk hemodialysis patients. Am J Nephrol. 2007;27:24–29
  24. Allon M. Dialysis catheter-related bacteremia: Treatment and prophylaxis. Am J Kidney Dis. 2004;44:779–791
  25. Dogra G. Preventing catheter-related infections with antibiotic lock solutions: Are we spoilt for choice?. Nephrology (Carlton). 2006;11:297–298
  26. Brown H, Prescott R. Applied Mixed Models in Medicine. Chichester, England: Wiley; 1999;
  27. Hsaio C. Analysis of Panel Data. Cambridge, UK: Cambridge University; 2003;
  28. Rabe-Hesketh S, Skrondal A. Multilevel and Longitudinal Modeling Using Stata. College Station, TX: Stata Press; 2005;
  29. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: A quantitative relationship between luminal colonization and duration of placement. J Infect Dis. 1993;168:400–407
  30. Dittmer ID, Sharp D, McNulty CA, Williams AJ, Banks RA. A prospective study of central venous hemodialysis catheter colonization and peripheral bacteremia. Clin Nephrol. 1999;51:34–39
  31. Rosett W, Hodges GR. Antimicrobial activity of heparin. J Clin Microbiol. 1980;11:30–34
  32. Shah CB, Mittelman MW, Costerton JW, et al. Antimicrobial activity of a novel catheter lock solution. Antimicrob Agents Chemother. 2002;46:1674–1679
  33. Percival SL, Kite P, Eastwood K, et al. Tetrasodium EDTA as a novel central venous catheter lock solution against biofilm. Infect Control Hosp Epidemiol. 2005;26:515–519
  34. Shanks RM, Sargent JL, Martinez RM, Graber ML, O'Toole GA. Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces. Nephrol Dial Transplant. 2006;21:2247–2255
  35. Nori US, Manoharan A, Yee J, Besarab A. Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia. Am J Kidney Dis. 2006;48:596–605
  36. Allon M. Prophylaxis against dialysis catheter-related bacteremia with a novel antimicrobial lock solution. Clin Infect Dis. 2003;36:1539–1544
  37. Shanks RM, Donegan NP, Graber ML, et al. Heparin stimulates Staphylococcus aureus biofilm formation. Infect Immun. 2005;73:4596–4606
  38. Jaffer Y, Selby N, Taal M, Fluck R, McIntyre CW. A meta-analysis of haemodialysis catheter locking solutions in the prevention of catheter related infection. Am J Kdney Dis. 2008;51:233–241
  39. Labriola L, Crott R, Jadoul M. Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: A meta-analysis of prospective randomized trials. Nephrol Dial Transplant. 2007;23:1666–1672
  40. Weijmer MC, van den Dorpel MA, Van de Ven PJ, et al. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol. 2005;16:2769–2777
  41. Betjes MG, van Agteren M. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution. Nephrol Dial Transplant. 2004;19:1546–1551
  42. Pervez A, Ahmed M, Ram S, et al. Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia. J Vasc Access. 2002;3:108–113
  43. Saxena AK, Panhotra BR, Sundaram DS, et al. Tunneled catheters' outcome optimization among diabetics on dialysis through antibiotic-lock placement. Kidney Int. 2006;70:1629–1635
  44. Geron R, Tanchilevski O, Kristal B. [Catheter lock solution—Taurolock for prevention of catheter-related bacteremia in hemodialysis patients]. Harefuah. 2006;145:881–884943
  45. Lambie SH, Hulme LJ, Taal M, Fluck RJ, McIntyre CW. Prospective study of gentamicin locking of tunnelled dialysis catheters: The effect on infection rates and CRP. Kidney Int. 2005;67:378
  46. Bleyer AJ, Mason L, Russell G, Raad II, Sherertz RJ. A randomized, controlled trial of a new vascular catheter flush solution (minocycline-EDTA) in temporary hemodialysis access. Infect Control Hosp Epidemiol. 2005;26:520–524
  47. Duncan N, Singh S, Amao M, et al. A single centre randomised control trial of sodium citrate versus heparin line locks for cuffed central venous catheters. J Am Soc Nephrol. 2007;16:451A;(abstr)
  48. D'Avella J, Li L, Qamar A, McDaniel A, Robbins K, Cooper B. A randomized trial of hypertonic saline and heparin lock solution in the prevention of hemodialysis catheter related bacteremia. J Am Soc Nephrol. 2007;18:461A;(abstr)
  49. Winnett G, Nolan J, Millar M, Ashman N. Trisodium citrate (TSC) selectively reduces staphylococcal catheter related bacteriaemia (CRB). J Am Soc Nephrol. 2007;18:460A;(abstr)
  50. Zhang P, Zhang W, He Q, et al. A randomized controlled study on prevention of cuff-tunneled catheter related bacteremia with gentamicin-heparin lock solution: The metaphase result. J Am Soc Nephrol. 2007;17:592A;(abstr)
  51. Ash S, Mankus R, Sutton J, et al. Concentrated sodium citrate (23%) for catheter lock. Hemodial Int. 2000;4:22–31
  52. Saxena AK, Panhotra BR, Sundaram DS, Morsy MN, Al-Ghamdi AM. Enhancing the survival of tunneled haemodialysis catheters using an antibiotic lock in the elderly: A randomised, double-blind clinical trial. Nephrology (Carlton). 2006;11:299–305
  53. Fluck RJ, McIntyre CW, Taal M. A one-year experience single center with antibiotic locking for tunneled venous catheters. J Am Soc Nephrol. 2006;17:591A;(abstr)
  54. Klevens RM, Tokars JI, Andrus M. Electronic reporting of infections associated with hemodialysis. Nephrol News Issues. 2005;19:37–3843
  55. Blankestijn PJ. Treatment and prevention of catheter-related infections in haemodialysis patients. Nephrol Dial Transplant. 2001;16:1975–1978
  56. Beathard GA. Catheter management protocol for catheter-related bacteremia prophylaxis. Semin Dial. 2003;16:403–405
  57. Katneni R, Hedayati SS. Central venous catheter-related bacteremia in chronic hemodialysis patients: Epidemiology and evidence-based management. Nat Clin Pract Nephrol. 2007;3:256–266
  58. Alexandraki I, Bhatt U, Plott D, Nakman N. Hemodialysis vascular catheter-related bacteremia: Five year epidemiological shift in organism isolates. J Am Soc Nephrol. 2005;16:453A;(abstr)
  59. Danese MD, Griffiths RI, Dylan M, Yu HT, Dubois R, Nissenson AR. Mortality differences among organisms causing septicemia in hemodialysis patients. Hemodial Int. 2006;10:56–62
  60. D'Agata EM. Antimicrobial-resistant, gram-positive bacteria among patients undergoing chronic hemodialysis. Clin Infect Dis. 2002;35:1212–1218
  61. Taal M, Fluck R, McIntyre C. Preventing catheter related infections in haemodialysis patients. Curr Opin Nephrol Hypertens. 2006;15:599–602
  62. Guerraoui A, Dacosta E, Roche B, et al. Emergence of multiresistant Staphylococcus epidermidis (MRSE) after lock antibiotic regimen by gentamicin in permanent hemodialysis catheters (Prospective study 1999-2003). J Am Soc Nephrol. 2004;15:368A;(abstr)
  63. Finger F, Rossaak M, Umstaetter R, Reulbach U, Pitto R. Skin infections of the limbs of Polynesian children. N Z Med J. 2004;117:U847
  64. Chambers S, Laing R, Murdoch D, et al. Maori have a much higher incidence of community-acquired pneumonia and pneumococcal pneumonia than non-Maori: Findings from two New Zealand hospitals. N Z Med J. 2006;119:U1978
  65. Tiu A, Martin R, Vanniasingham P, MacCormick AD, Hill AG. Necrotizing fasciitis: Analysis of 48 cases in South Auckland, New Zealand. ANZ J Surg. 2005;75:32–34
  66. Lawton B, Rose S, Bromhead C, Brown S, MacDonald J, Shepherd J. Rates of Chlamydia trachomatis testing and chlamydial infection in pregnant women. N Z Med J. 2004;117:U889
  67. Weir RP, Brunton CR, Blakely TA. Chronic liver disease mortality attributable to hepatitis B and C in New Zealand. J Gastroenterol Hepatol. 2002;17:582–588
  68. Wilson N, Baker M, Martin D, et al. Meningococcal disease epidemiology and control in New Zealand. N Z Med J. 1995;108:437–442
  69. Ellison-Loschmann L, Pearce N. Improving access to health care among New Zealand's Maori population. Am J Public Health. 2006;96:612–617
  70. Yang LP, Eriksson BK, Harrington Z, et al. Variations in the protective immune response against streptococcal superantigens in populations of different ethnicity. Med Microbiol Immunol. 2006;195:37–43
  71. Conley J, James M, MacRae J, et al. Antimicrobial agents for the prophylaxis of catheter related bloodstream infections in hemodialysis patients: A systematic review and meta-analysis. J Am Soc Nephrol. 2007;18:463A;(abstr)

 Originally published online as doi:10.1053/j.ajkd.2008.09.019 on January 16, 2009.

PII: S0272-6386(08)01567-9

doi: 10.1053/j.ajkd.2008.09.019

American Journal of Kidney Diseases
Volume 53, Issue 3 , Pages 492-502 , March 2009