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2015 | 86 | 12 | 563-568
Tytuł artykułu

The Efficacy of Alcohol-Antibiotic Lock Therapy for Treatment of Catheter Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
In patients with chronic gastrointestinal tract failure, requiring access to the venous system, the subsequent catheter re-insertion are leading to large veins thrombosis impeding or preventing the insertion of another catheter and exposing patients to the risk of complications. Understanding the pathophysiology of catheter-related infections, enabled to use methods allowing to eradicate the source of infection without removal and replacement of central catheter with a new one. In our center, for many years we have been using an alternative method involving implementation of the alcohol-antibiotic lock in the treatment of infections. This method is based on the assumption that the destruction of biofilm with concentrated alcohol will enable antibiotic penetration and killing other microorganisms. Treatment with alcohol-antibiotic lock lasts from 8 to 10 days and involves filling the catheter with 96% alcohol followed by a solution of the antibiotic of high concentration. The aim of the study was to evaluate the efficacy of treatment of catheter-related bloodstream infections with two methods (catheter replacement with a new one and the alcohol-antibiotic lock therapy) in patients receiving home parenteral nutrition (HPN). Material and methods. 428 HPN in the period from 1 January 2005 to 31 December 2010. Among which 240 (56%) of women with an average age of 56.5±16 years and 188 (44%) of men with an average age of 54±17 years. The indications to HPN were as follows: short bowel syndrome in 298 (70%) patients, multilevel obstruction of the gastrointestinal tract in 52 (12%), postoperative gastrointestinal fistulas in 48 (11.2%), malabsorption syndrome in 17 (4%), motility disorders in 6, cachexia in 4 and radiation enteritis in 3 patients. Results. In 247 (57.5%) from 428 patients, no episode of catheter-related bloodstream infection was found, while 181 were diagnosed with 352 episodes of catheter-related bloodstream infections. In 40 (9.4%) from 428 patients, 168 (47.8%) episodes have been found - almost a half. The mean duration of treatment of patients receiving home parenteral nutrition, starting from the first episode of catheterrelated bloodstream infection, in 48 patients treated with the lock was equal to 1053+748 days, and in 133 patients treated with catheter replacement was equal to 952+709 days (t-test p = 0.62). Conclusions. The survival time of patients treated with alcohol-antibiotic lock is the same as in patients treated with the catheter removal and insertion of the new one. The use of alcohol-antibiotic lock to treat catheter-related bloodstream infections in order to eradicate selected microorganisms that colonize the lumen and cause an infection, is as effective as catheter replacement with a new one.
Wydawca

Rocznik
Tom
86
Numer
12
Strony
563-568
Opis fizyczny
Daty
otrzymano
2014-09-29
online
2015-03-01
Twórcy
  • Department of General Surgery and Clinical Nutrition, Warsaw Medical University Kierownik: dr hab. J. Sobocki, Michal-lawinski@wp.pl
  • Department of General Surgery and Clinical Nutrition, Warsaw Medical University Kierownik: dr hab. J. Sobocki
  • Department of General Surgery and Clinical Nutrition, Warsaw Medical University Kierownik: dr hab. J. Sobocki
  • Department of Personality, University of Social Sciences and Humanities in Warsaw Kierownik: prof. dr hab. J. Trzebiński
Bibliografia
  • 1. Mermel LA, Allon M, Bouza E et al.: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1; 49(1): 1-45. No abstract available. Erratum in: Clin Infect Dis. 2010 Feb 1; 50(3): 457. Clin Infect Dis 2010 Apr 1; 50(7): 1079.[Crossref]
  • 2. Manierski C, Besarab A: Antimicrobial locks: putting the lock on catheter infections. Adv Chronic Kidney Dis 2006 Jul; 13(3): 245-58.
  • 3. Del Pozo JL: Role of antibiotic lock therapy for the treatment of catheter-related bloodstream infections. Int J Artif Organs 2009 Sep; 32(9): 678-88.[PubMed]
  • 4. Segarra-Newnham M, Martin-Cooper EM: Antibiotic lock technique: a review of the literature. Ann Pharmacother 2005 Feb; 39(2): 311-18.[Crossref]
  • 5. Crnich CJ, Halfmann JA, Crone WC, Maki DG: The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol 2005 Aug; 26(8): 708-14.
  • 6. Johnston DA, Walker K, Richards J, Pennington CR: Ethanol flush for the prevention of catheter occlusion. Clin Nutr 1992 Apr; 11(2): 97-100.[PubMed][Crossref]
  • 7. Mermel LA, Allon M, Bouza E et al.: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009 Jul 1; 49(1): 1-45.[Crossref]
  • 8. Sitges-Serra A, Girvent M: Elimination of intraluminal colonization by antibiotic lock in silicone vascular catheters. Nutrition 1998 Sep; 14(9): 715- 16.
  • 9. Messing B, Man F, Colimon R et al.: Antibioticlock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition. Clin Nutr 1990 Aug; 9(4): 220-25.[PubMed][Crossref]
  • 10. Johnson DC, Johnson FL, Goldman S: Preliminary results treating persistent central venous catheter infections with the antibioticlock technique in pediatric patients. Pediatr Infect Dis J 1994 Oct; 13(10): 930-31.[PubMed][Crossref]
  • 11. Fortún J, Grill F, Martín-Dávila P et al.: Treatment of long-term intravascular catheter-related bacteraemiawith antibiotic-lock therapy. J Antimicrob Chemother 2006 Oct; 58(4): 816-21.[PubMed]
  • 12. Rijnders BJ, Van Wijngaerden E, Vandecasteele SJ et al.: Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial. J Antimicrob Chemother 2005 Jan; 55(1): 90-94.[PubMed]
  • 13. Fernandez-Hidalgo N, Almirante B, Calleja R et al.: Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study. J Antimicrob Chemother 2006 Jun; 57(6): 1172-80.
  • 14. Viale P, Pagani L, Petrosillo N et al.: Italian Hospital and HIV Infection Group.: Antibiotic locktechnique for the treatment of catheter-related bloodstream infections. J Chemother 2003; 15(2): 152-56.[PubMed]
  • 15. Castagnola E, Bandettini R, Lorenzi I et al.: Catheter-related bacteremia caused by methicillinresistant coagulase negative staphylococci with elevated minimal inhibitory concentration for vancomycin. Pediatr Infect Dis J 2010 Nov; 29(11): 1047-48.[WoS]
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_1515_pjs-2015-0002
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