Prophylaxis with gentamicin locking of chronic tunneled central venous catheter does not cause bacterial resistance

被引:12
作者
Fernandez-Gallego, J. [1 ]
Martin, M. [1 ]
Gutierrez, E. [1 ]
Cobelo, C. [1 ]
Frias, P. [1 ]
Jironda, C. [1 ]
Hidalgo, P. [1 ]
Jimenez, T. [1 ]
机构
[1] Hosp Carlos Haya, Serv Nefrol, Malaga, Spain
来源
NEFROLOGIA | 2011年 / 31卷 / 03期
关键词
Hemodialysis; Catheter; Bacteremia; Prophylaxis; Gentamicin; Gentamicin bacterial resistance; HEMODIALYSIS CATHETERS; VASCULAR ACCESS; METAANALYSIS; PREVENTION; BACTEREMIA;
D O I
10.3265/Nefrologia.pre2011.Feb.10257
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Prophylaxis with gentamicin locking of chronic tunneled central venous catheter branches in chronic hemodialysis reduces bacterial infections and morbidity and mortality associated with catheter bacteremia. Aim: We undertook a 7-year, prospective, observational study involving 101 patients on chronic hemodialysis with catheters treated with prophylaxis to evaluate the appearance of bacterial resistance to the antibiotic in pathogens usually sensitive to its action. Material and methods: A protocol of universal asepsis in catheter management. Postdialysis intraluminal locking of the branches with gentamicin 5 mg/branch + 1% heparin sodium, monitoring trough levels in blood and modifying the dose according to the established protocol. The diagnosis of bacteremia was based on usual criteria. The main study variables were: Diagnosis for bacteriology deparment of bacterial resistance in pathogens sensitive to gentamicin. Diagnosis of clinical ototoxicity. Secondary variables were: Patients hospitalized/bacteremia; number of bacteremia/catheter/1000 days; infectious mortality and catheter withdrawal/bacteremia. Pathogens found in blood culture. Results: Main variables: We found no resistance of pathogens usually sensitive to the antibiotic. Nor was there clinical ototoxicity. The mean number of months each patient remained in the study was 23 (1-84). Secondary variables: Three patients (3%) were hospitalized due to bacteremia; number of bacteremias, 8; number of bacteremia/catheter/1000 days, 0.11; infectious mortality per bacteremia, 1 patient (1%); catheter withdrawal due to bacteremia, 2 (2%). No patients were diagnosed with endocarditis or spondylodiscitis. The mean trough level of gentamicin of each patient during the study was 0.17 mu g/ml (0.05-0.31); the mean intraluminal gentamicin locking dose per branch was 3 mg (2-5), equivalent to 1.1-1.7 mg/ml/branch. Conclusions: This 7-year, prospective observational study of 101 patients on chronic hemodialysis with tunneled central venous catheters showed: 1) Prophylaxis with intraluminal gentamicin locking of the catheter branches does not cause bacterial resistance in pathogens sensitive to its action. 2) No clinical ototoxicity was seen. 3) Prophylaxis with the low-dose gentamicin administered compared with the greater doses used in other studies can influence the lack of appearance of resistance and ototoxicity.
引用
收藏
页码:308 / 312
页数:5
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