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Antibiotic lock solutions allow less systemic antibiotic exposure and less catheter malfunction without adversely affecting antimicrobial resistance patterns
Author(s) -
Onder Ali Mirza,
Billings A. A.,
Chandar Jayanthi,
Nield Linda,
Francoeur Denise,
Simon Nancy,
Abitbol Carolyn,
Zilleruelo Gaston
Publication year - 2013
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00717.x
Subject(s) - medicine , bacteremia , antibiotics , gentamicin , antibiotic resistance , vancomycin , tobramycin , hemodialysis , population , antimicrobial , drug resistance , catheter , intensive care medicine , surgery , microbiology and biotechnology , staphylococcus aureus , biology , bacteria , genetics , environmental health
There are current concerns that antibiotic lock solutions ( ABL ) can induce antimicrobial resistance in long‐term hemodialysis patients. Retrospective chart review of 157 children on hemodialysis between J anuary 1997 and J une 2006 was performed. In ERA I , only systemic antibiotics were used. In ERA II , ABL were added to systemic antibiotics when needed. In ERA III , ABL were used for treatment of all cases of catheter‐related bacteremia ( CRB ) and for CRB prophylaxis in high‐risk patients. The study includes 111,325 catheter days. The CRB incidence was 3.9 CRB /1000 catheter days. There was significant decrease for the total systemic antibiotic exposure ( P = 0.0484) and the percentage of catheters lost to malfunction ( P = 0.001) in ERA III . Protocol ABL exposure was associated with a trend to increased tobramycin‐gentamicin resistance for gram‐positive CRB s ( P = 0.2586) but with improved tobramycin‐gentamicin resistance for gram‐negative ( P = 0.0949) and polymicrobial CRB s ( P = 0.1776) and improved vancomycin resistance for gram‐positive CRB s ( P = 0.0985). This retrospective analysis does not support the premise that ABL use will promote antimicrobial resistance in the hemodialysis population. The decreased exposure to systemic antibiotics by vigorous ABL use may even improve the antimicrobial resistance patterns in this population in the long term.