Antifungal Lock Therapy

The widespread use of intravascular devices, such as central venous and hemodialysis catheters, in the past 2 decades has paralleled the increasing incidence of catheter-related bloodstream infections (CR-BSIs).Candida albicans is the fourth leading cause of hospital-associated BSIs. The propensity ofC. albicans to form biofilms on these catheters has made these infections difficult to treat due to multiple factors, including increased resistance to antifungal agents. Thus, curing CR-BSIs caused byCandida species usually requires catheter removal in addition to systemic antifungal therapy. Alternatively, antimicrobial lock therapy has received significant interest and shown promise as a strategy to treat CR-BSIs due toCandida species. The existingin vitro , animal, and patient data for treatment ofCandida -related CR-BSIs are reviewed. The most promising antifungal lock therapy (Af LT) strategies include use of amphotericin, ethanol, or echinocandins. Clinical trials are needed to further define the safety and efficacy of Af LT.