my personal edition > dialysis > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Antibiotic-Heparin Mix Successfully Treats Sepsis Related to Dialysis Catheters: Presented at ASN

By Michael Smith
Special to DG News

PHILADELPHIA, PA -- November 3, 2002 -- A prepared combination of antibiotics and heparin is a simple solution to sepsis related to dialysis catheters, British researchers reported here November 1 at the 35^th annual meeting of the American Society of Nephrology.

Sepsis is the main factor that limits the use of tunneled dialysis catheters, said Dr. Anand Vardhan of the department of nephrology at Arrowe Park Hospital, in Wirral, Merseyside, United Kingdom. A 2000 study (Stevenson, KB et al, Infect Control Hosp Epidemiol 2000 Mar;21(3):200-3) showed an average time-adjusted infection rate of 14 for every 1,000 catheter-days.

But systemic antibiotics often fail to achieve therapeutic levels in catheter lumens and are therefore inadequate to treat sepsis if used alone, Dr. Vardhan said.

In his hospital, he said, the pharmacists prepared "antibiotic-heparin locks," consisting of vancomycin (100 µg/mL), gentamicin (20 µg/mL), and heparin (3500 U/mL). In cases of catheter-related sepsis, the combination was used in conjunction with IV antibiotics to clean out the catheters.

Patients with tunneled dialysis lines and clinical features of sepsis had blood cultures taken from both ports of the line and peripherally, followed by IV vancomycin and gentamicin. The lines were then "locked" with the prepared antibiotic-heparin mixture for 48 hours, until the next dialysis session. The process was repeated for two weeks, although if patients remained unwell, the lines were removed.

In 32 cases of suspected sepsis involving 25 patients, Dr. Vardhan said, the procedure resulted in a 66 percent success rate for the protocol, allowing the line to remain in place, and a clinical cure rate of 85 percent.

Six of the 32 suspected episodes were excluded from the analysis. In one case, the cultures were negative; in three cases, the cultures were contaminated; in one case the line was dislodged; one line was removed as no longer needed.

Dr. Vardhan noted that clinical cure may not mean that organisms have been completely eradicated from the dialysis lines, and it remains unclear whether colonised lines should be removed, monitored, or treated with a prolonged course of antibiotic locks alone.

E-Mail this DGDispatch to a colleague

To print, use this version