Document Detail


Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis.
MedLine Citation:
PMID:  20595689     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related blood stream infections (CRIs), but there are no data regarding the long-term consequences of this practice.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Over a 4-year period, from October 1, 2002, to September 30, 2006, we initiated a gentamicin and heparin lock (GHL) protocol in 1410 chronic hemodialysis patients receiving dialysis through a tunneled catheter in eight outpatient units.
RESULTS: Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006.
CONCLUSIONS: Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.
Authors:
Daniel L Landry; Gregory L Braden; Stephen L Gobeille; Sarah D Haessler; Chirag K Vaidya; Stephen J Sweet
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Publication Detail:
Type:  Journal Article     Date:  2010-07-01
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  5     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-08     Completed Date:  2011-01-21     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1799-804     Citation Subset:  IM    
Affiliation:
Baystate Medical Center, Division of Nephrology, 759 Chestnut Street, Springfield, MA 01199, USA. daniel.landry@bhs.org
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care
Anti-Bacterial Agents / adverse effects,  therapeutic use*
Antibiotic Prophylaxis* / adverse effects
Anticoagulants / therapeutic use
Catheter-Related Infections / microbiology,  mortality,  prevention & control*
Catheters, Indwelling / adverse effects*
Chi-Square Distribution
Drug Resistance, Bacterial*
Endocarditis, Bacterial / microbiology
Equipment Design
Female
Gentamicins / adverse effects,  therapeutic use*
Heparin / therapeutic use
Humans
Male
Massachusetts
Middle Aged
Program Evaluation
Renal Dialysis / adverse effects*,  instrumentation
Retrospective Studies
Shock, Septic / microbiology
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anticoagulants; 0/Gentamicins; 9005-49-6/Heparin
Comments/Corrections

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


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