Antibiotic lock treatment of catheter-related sepsis

The diagnosis of catheter-related infection (CRI) is based on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by microbes. To confirm colonization, a number of procedures are used. Conventional management of CRI involves decisions regarding the necessity of the removal of the catheter and the administration of antibiotics. This is a review of the diagnosis and conventional management of CRI, with the indications and the clinical experience with the antibiotic lock treatment (ALT) to date. ALT is recommended particularly for treatment of intraluminal origin noncomplicated central venous CRI and has been performed in patients with various diseases (AIDS, cancer) or conditions (parenteral nutrition, dialysis). Overall, therapeutic success with central venous catheter salvage has been achieved in 112 (86%) of 130 episodes of bacterial sepsis. ALT is also indicated for chamber infections (whether or not they are associated with bacteremia) and it can prevent catheter-related bacteremia in cancer patients. ALT must be avoided for the treatment of complicated CRI, as well as in cases with evidence of extraluminal infection (inflammation over the tunnel or exit site or pocket of a totally implanted port). The majority of failures have been observed in cases of intraluminal origin catheter-related Candida infections. In catheter-related bloodstream infections due to Staphylococcus aureus, the catheter should be removed immediately because of the high risk of metastatic infection and increased mortality, and the S. aureus infections should be treated with appropriate antibiotics given intravenously. Antibiotic solution containing the desired antimicrobial agent in a suitable concentration (100-1000 times greater than the peak serum inhibitory concentrations achieved by conventional dosage of the corresponding systemic antibiotic) is usually mixed with 50-100 IU of heparin (or normal saline) in sufficient (usually 2-5 mL) volume. The antibiotic solution is installed in the catheter lumen during periods(usually 8-12 hours) when the catheter is not being used. The installed antibiotic is removed before infusion of the next dose of antibiotic or intravenous medication. The duration of ALT is most often 2 weeks.