The Effectiveness of Antibiotic-Lock Therapy for the Prevention of Catheter-Related Bacteremia in Patients on Chronic Hemodialysis: Case Controlled Study in a Veteran Population

Central venous catheters (CVCs) are frequently used in patients with chronic renal failure who require long-term hemodialysis. CVCs are also known to be a major source of bloodstream infections. Though antibiotic-lock therapy (ALT) has previously been used to prevent and treat catheter-related infections, the use of ALT remains controversial due to the lack of large prospective randomized controlled trials. The purpose of this study was to evaluate the effectiveness of ALT in the prevention of catheter-related bacteremia (CRB) in a veteran population who required chronic hemodialysis. This was a retrospective, case-controlled study. All patients who underwent hemodialysis using a tunneled central catheter (TCC) from January 1, 2006 to October 8, 2008 were examined. Eleven patients who received ALT were compared with 15 case control subjects. The effectiveness of ALT for prevention of CRB was determined by the incidence of CRBs during the study period and catheter removal secondary to a CRB. A total of 10,961 catheter-days were calculated from 47 TCCs among 26 patients. The two groups had similar demographics and risk factors for CRBs. There were a total of 17 incidences of CRBs with a rate of 1.55 incidences/1,000 catheter-days. The rate of CRB was significantly lower in the ALT group (0.69 incidences/1,000 catheter-days) than the control group (2.54 incidences/1,000 catheter-days), p=0.041. The rate of catheters removal due to a CRB was also significantly less in the ALT group (0.5 catheter removed/1,000 catheter-days) than the control group (2.41 catheter removed/1,000 catheter-days), p=0.041. Seven out of 9 patients died in the control group secondary to CRBs. Three patients died in the ALT group; however none of these deaths were associated with CRB. Our study results revealed that ALT is an effective way to prevent catheter related bacteremia among veterans with central venous catheter for chronic hemodialysis