Journal Article

Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial

Bart J. Rijnders, Eric Van Wijngaerden, Stefaan J. Vandecasteele, Marguerite Stas and Willy E. Peetermans

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 55, issue 1, pages 90-94
Published in print January 2005 | ISSN: 0305-7453
Published online January 2005 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh488
Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial

More Like This

Show all results sharing these subjects:

  • Medical Oncology
  • Critical Care

GO

Show Summary Details

Preview

Objectives: The use of an antibiotic lock (AB-lock) for the treatment of catheter-related bloodstream infection (CRBSI) has been suggested, but randomized trials have never been performed.

Methods: A randomized, blinded, multicentre trial was set up to compare an AB-lock—containing vancomycin for Gram-positive or ceftazidime for Gram-negative bacteria—with placebo, in addition to parenteral AB therapy. We included only CRBSI from a long-term intravascular device (LTID) whether tunnelled or totally implanted.

Results: During 30 months, 174 patients with an LTID and bacteraemia were evaluated, of whom 85 had a CRBSI. Forty-six patients were included. Frequent reasons for exclusion were: catheter not vacant for >8–12 h/day for the AB-lock (n =10); yeast infection or mixed Gram-positive/negative infections (n =13); catheter removal preferred by the treating physician (n =7); and CRBSI <14 days after insertion or pocket/tunnel infection (n =10). Forty-four patients met the criteria for modified intention-to-treat analysis. The primary endpoint was failure to cure the CRBSI or relapse with the same strain. On study day 180 by Kaplan–Meier analysis, this occurred in 33% (seven of 21) in the AB-lock arm and in 57% (13 of 23) in the placebo arm (hazard ratio 0.55, P =0.10). A relapse with the same strain occurred in 9/23 with the placebo and 3/21 with the AB-lock (P =0.06).

Conclusion: Future studies should take into account the barriers to the use of AB-lock observed in this study. Most importantly, shorter lock dwell times and broader spectrum locks (e.g. antiseptic) should be investigated to target a larger patient population.

Keywords: infections; sepsis; treatment; ceftazidime; vancomycin

Journal Article.  3845 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.