| Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. | |
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MedLine Citation:
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PMID: 20595689 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Daniel L Landry; Gregory L Braden; Stephen L Gobeille; Sarah D Haessler; Chirag K Vaidya; Stephen J Sweet |
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Publication Detail:
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Type: Journal Article Date: 2010-07-01 |
Journal Detail:
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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:
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Created Date: 2010-10-08 Completed Date: 2011-01-21 Revised Date: 2013-05-29 |
Medline Journal Info:
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Nlm Unique ID: 101271570 Medline TA: Clin J Am Soc Nephrol Country: United States |
Other Details:
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Languages: eng Pagination: 1799-804 Citation Subset: IM |
Affiliation:
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Baystate Medical Center, Division of Nephrology, 759 Chestnut Street, Springfield, MA 01199, USA. daniel.landry@bhs.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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