Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial
Background: Catheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased e...
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doaj-8d1571689f374318ac45320af8e99df42020-11-24T21:55:49ZengElsevierInternational Journal of Infectious Diseases1201-97122019-08-01851621Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trialTricya Nunes Vieira Bueloni0Daniel Marchi1Camille Caetano2Ricardo de Souza Cavalcante3Marcela Lara Mendes Amaral4Daniela Ponce5Dialysis Center, Bauru State Hospital, Bauru, São Paulo, BrazilDialysis Center, Bauru State Hospital, Bauru, São Paulo, BrazilDialysis Center, Botucatu School of Medicine, UNESP, Sao paulo, BrazilDialysis Center, Botucatu School of Medicine, UNESP, Sao paulo, BrazilDialysis Center, Botucatu School of Medicine, UNESP, Sao paulo, BrazilDialysis Center, Botucatu School of Medicine, UNESP, Sao paulo, Brazil; Corresponding author.Background: Catheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be investigated further. The aim of this study was to compare the efficacy of lock solution using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects. Methods: A prospective observational study was performed at two dialysis centers. Patients using new tunneled central venous catheters (CVC) for HD were included. Patients with a tunneled CVC were assigned to receive either antibiotic lock solution (group 1: gentamicin 7 mg/ml + cefazolin 12 mg/ml + heparin 3500 IU/ml) or lock solution with TauroLock-Hep500 (group 2: taurolidine citrate 4% + heparin 500 IU/ml) during the inter-dialysis period. The patients were allocated to these groups according to the hemodialysis center they were attending. Results: A total of 145 CVCs were implanted in 127 patients and were followed for 15 months: 77 CVCs (65 patients) were placed in group 1 and 68 CVCs (62 patients) in group 2. There was no difference between the two groups with regard to CR-BSI (events per 1000 catheter-days: group 1 = 0.79, group 2 = 1.10; p = 0.18) or exit site infection rates (events per 1000 catheter-days: group 1 = 2.45, group 2 = 1.83; p = 0.37). The groups differed in ESI pathogens, with gram-positive oxacillin-resistant pathogens more frequent in group 1 (31.8% vs. 5.0%; p = 0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all catheter removal complications (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.19–0.91) and mechanical complications (HR 0.16, 95% CI 0.065–0.41); only ESI was a risk factor for all catheter removal complications (HR 1.79, 95% CI 1.04–3.07) and mechanical complications (HR 5.64, 95% CI 1.65–19.3). Conclusions: The efficacy of both lock solutions was similar in preventing infections related to tunneled CVCs for HD. However, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for lock solution and the associated adverse effects. Keywords: Hemodialysis, Tunneled catheter, Catheter-related bloodstream infection, Lock therapyhttp://www.sciencedirect.com/science/article/pii/S1201971219302231 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tricya Nunes Vieira Bueloni Daniel Marchi Camille Caetano Ricardo de Souza Cavalcante Marcela Lara Mendes Amaral Daniela Ponce |
spellingShingle |
Tricya Nunes Vieira Bueloni Daniel Marchi Camille Caetano Ricardo de Souza Cavalcante Marcela Lara Mendes Amaral Daniela Ponce Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial International Journal of Infectious Diseases |
author_facet |
Tricya Nunes Vieira Bueloni Daniel Marchi Camille Caetano Ricardo de Souza Cavalcante Marcela Lara Mendes Amaral Daniela Ponce |
author_sort |
Tricya Nunes Vieira Bueloni |
title |
Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial |
title_short |
Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial |
title_full |
Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial |
title_fullStr |
Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial |
title_full_unstemmed |
Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial |
title_sort |
cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: a quasi-experimental trial |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 |
publishDate |
2019-08-01 |
description |
Background: Catheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be investigated further. The aim of this study was to compare the efficacy of lock solution using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects. Methods: A prospective observational study was performed at two dialysis centers. Patients using new tunneled central venous catheters (CVC) for HD were included. Patients with a tunneled CVC were assigned to receive either antibiotic lock solution (group 1: gentamicin 7 mg/ml + cefazolin 12 mg/ml + heparin 3500 IU/ml) or lock solution with TauroLock-Hep500 (group 2: taurolidine citrate 4% + heparin 500 IU/ml) during the inter-dialysis period. The patients were allocated to these groups according to the hemodialysis center they were attending. Results: A total of 145 CVCs were implanted in 127 patients and were followed for 15 months: 77 CVCs (65 patients) were placed in group 1 and 68 CVCs (62 patients) in group 2. There was no difference between the two groups with regard to CR-BSI (events per 1000 catheter-days: group 1 = 0.79, group 2 = 1.10; p = 0.18) or exit site infection rates (events per 1000 catheter-days: group 1 = 2.45, group 2 = 1.83; p = 0.37). The groups differed in ESI pathogens, with gram-positive oxacillin-resistant pathogens more frequent in group 1 (31.8% vs. 5.0%; p = 0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all catheter removal complications (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.19–0.91) and mechanical complications (HR 0.16, 95% CI 0.065–0.41); only ESI was a risk factor for all catheter removal complications (HR 1.79, 95% CI 1.04–3.07) and mechanical complications (HR 5.64, 95% CI 1.65–19.3). Conclusions: The efficacy of both lock solutions was similar in preventing infections related to tunneled CVCs for HD. However, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for lock solution and the associated adverse effects. Keywords: Hemodialysis, Tunneled catheter, Catheter-related bloodstream infection, Lock therapy |
url |
http://www.sciencedirect.com/science/article/pii/S1201971219302231 |
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