Document Detail


Catheter-related bacteremia in hemodialysis: which preventive measures to take?
MedLine Citation:
PMID:  18974657     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The use of tunneled hemodialysis catheters as definitive vascular access is becoming increasingly more widespread, reaching 25% of all dialysis patients in some countries. The rate of infectious morbidity and mortality is much higher when catheters are used than when patients are dialyzed through grafts or native fistulas, and it is generally agreed that implementing appropriate preventive measures would do more to lower its incidence. METHODS: A prospective, randomized, open-label, long-term follow-up clinical trial was conducted to compare the efficacy of dressing the exit site with antibiotic ointment (AO) versus catheter antimicrobial locking (AL) in preventing catheter-related bacteremia (CRB), both associated with strict standard precautions and appropriate catheter care. A total of 141 tunneled catheters, newly implanted in 116 consecutive patients, were followed during a 2-year period. Patients were randomly distributed into one of three arms, with group A receiving AO prophylaxis, group B treated with a heparin + gentamicin (5.2 mg/ml) lock (AL) and group C receiving both AO and AL prophylaxis. RESULTS: Group A had a significantly lower infection-free time survival curve (p < 0.02, Kaplan-Meier) with a catheter survival of 103.9 days and a significantly higher number of CRB (9 episodes, p < 0.02, chi(2)). Group B had 130.7 mean infection-free days and 1 episode of CRB. Group C had 127.3 mean infection-free days and 5 episodes of CRB. No toxicity or other adverse events were observed during this 2-year period, and the efficacy of the preventive measures remained stable throughout. CONCLUSION: Antimicrobial lock is superior to AO as a CRB preventive measure. The use of lock and ointment in the same catheter was not associated with additive effects.
Authors:
Jorge Silva; Teixeira e Costa; Alexandre Baptista; Aura Ramos; Pedro Ponce
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-10-31
Journal Detail:
Title:  Nephron. Clinical practice     Volume:  110     ISSN:  1660-2110     ISO Abbreviation:  Nephron Clin Pract     Publication Date:  2008  
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101159763     Medline TA:  Nephron Clin Pract     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  c251-7     Citation Subset:  IM    
Copyright Information:
(c) 2008 S. Karger AG, Basel.
Affiliation:
Department of Nephrology, Hospital Garcia de Orta, Almada, Portugal. jorgesilva1@sapo.pt
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MeSH Terms
Descriptor/Qualifier:
Aged
Bacteremia / mortality*,  prevention & control*
Catheterization, Central Venous / instrumentation,  mortality*
Comorbidity
Female
Humans
Incidence
Kidney Failure, Chronic / metabolism*,  rehabilitation*
Male
Portugal / epidemiology
Renal Dialysis / instrumentation,  mortality*
Risk Assessment / methods
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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