Carol L. Moore Anatole Besarab Marie Ajluni Vivek Soi Edward L. Peterson Laura E. Johnson Marcus J. Zervos Elizabeth Adams Jerry Yee
Background and objectives Infection is the second leading cause of death in hemodialysis patients. Catheterrelated bloodstreaminfection and infection-relatedmortality have not improved in this populat..
Background and objectives Infection is the second leading cause of death in hemodialysis patients. Catheterrelated bloodstreaminfection and infection-relatedmortality have not improved in this population over the past two decades. This study evaluated the impact of a prophylactic antibiotic lock solution on the incidence of catheter-related bloodstream infection and mortality. Design, setting, participants, & measurements This prospective, multicenter, observational cohort study compared the effectiveness of two catheter locking solutions (gentamicin/citrate versus heparin) in 555 hemodialysis patients dialyzing with a tunneled cuffed catheter between 2008 and 2011. The groups were not mutually exclusive. Rates of catheter-related bloodstream infection and mortality hazards were compared between groups. Results The study population (n=555 and 1350 catheters) had amedian age of 62 years (interquartile range=41–83 years), with 50% men and 71% black. There were 427 patients evaluable in the heparin period (84,326 days) and 322 patients evaluable in the antibiotic lock period (71,192 days). Catheter-related bloodstream infection in the antibiotic lock period (0.45/1000 catheter days)was 73%lower than the heparin period (1.68/1000 catheter days; P=0.001).Antibiotic lock usewas associatedwith a decreased risk of catheter-related bloodstream infection compared with heparin (risk ratio, 0.23; 95% confidence interval, 0.13 to 0.38 after multivariate adjustment). Cox proportional hazards modeling found that antibiotic lock was associated with a reduction in mortality (hazard ratio, 0.36; 95% confidence interval, 0.22 to 0.58 in unadjusted analyses; hazard ratio, 0.32; 95% confidence interval, 0.14 to 0.75 after multivariate adjustment). The rate of gentamicin-resistant organisms decreased (0.40/1000 person-years to 0.22/1000 person-years) in the antibiotic lock period (P=0.01). Conclusions The results of this study show that the use of a prophylactic, gentamicin/citrate lock was associated with a substantial reduction in catheter-related bloodstream infection and is the first to report a survival advantage of antibiotic lock in a population at high risk of infection-related morbidity and mortality.