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Treatment of catheter-related bacteremia with tissue plasminogen activator antibiotic locks

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Abstract

This retrospective study was completed to investigate the effectiveness of tissue plasminogen activator (TPA) antibiotic locks (ABL) along with systemic antibiotics (AB) to clear catheter-related bacteremia (CRB) in children on chronic hemodialysis. There were 76 CRBs in 37 children. CRBs were successfully cleared with AB/ABL in 63/76 (83%) cases. Ten of 76 (13%) CRBs were symptomatic at 48 h of treatment. These were seven polymicrobial, two gram-negative, and one Candida CRB. 13/76 (17%) episodes required catheter exchange, and all were wire-guided exchanges. TPA-ABL/AB cleared gram-positive and gram-negative CRBs significantly better than polymicrobial CRBs (p < 0.01). The infection-free survival and the rate of recurrence at 45 days was not statistically different between the TPA-ABL/AB group and the catheter-exchange group. If CRB was symptomatic at 48 h of treatment, recurrence at 6 weeks was more frequent with persistent use of TPA-ABL/AB (p < 0.05). There were no episodes of metastatic infections, catheter malfunction from occlusion, or catheter breakdown during the course of TPA-ABL treatments. In conclusion, TPA-ABL can be safely and effectively used in the management of CRB, increasing the probability of catheter survival and preserving the vascular access site. With the exception of polymicrobial CRB, there is no disadvantage in using TPA-ABL/AB over catheter exchange, as the infection-free survival and the rate of recurrence are comparable.

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References

  1. NKF K/DOQI Guidelines (2006) Clinical Practice Guidelines for Vascular Access, Update http://www.kidney.org

  2. Besarab A, Adams M, Amatucci S, Bowe D, Deane J, Ketchen K, Reynolds K, Tello A (2000) Unraveling the realities of vascular access: the Network 11 experience. Adv Ren Replace Ther 7(1):S65–S70

    PubMed  CAS  Google Scholar 

  3. Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, Wolfe RA, Goodkin DA, Held PJ (2002) Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 61:305–316

    Article  PubMed  Google Scholar 

  4. Centers for Medicare & Medicaid Services (2005) 2005 Annual Report, End-Stage Renal Disease Clinical Performance Measures Project. Baltimore, MD, Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Beneficiary Choices

  5. Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL (2004) Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines. Am J Kidney Dis 44:S22–S26

    Article  Google Scholar 

  6. Lumsden AB, MacDonald MJ, Allen RC, Dodson TF (1994) Hemodialysis access in the pediatric patient population. Am J Surg 168:197–201

    Article  PubMed  CAS  Google Scholar 

  7. Ramage IJ, Bailie A, Tyerman KS, McColl JH, Pollard SG, Fitzpatrick MM (2005) Vascular access survival in children and young adults receiving long-term hemodialysis. Am J Kidney Dis 45:708–715

    Article  PubMed  Google Scholar 

  8. Bourquelot P, Raynaud F, Pirozzi N (2003) Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases. Ther Apher Dial 7:498–503

    Article  PubMed  Google Scholar 

  9. Gradman WS, Lerner G, Mentser M, Rodriguez H, Kamil ES (2005) Experience with autogenous arteriovenous access for hemodialysis in children and adolescents. Ann Vasc Surg 19:609–612

    Article  PubMed  Google Scholar 

  10. Onder AM, Chandar J, Coakley S, Abitbol C, Montane B, Zilleruelo G (2006) Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis. Pediatr Nephrol 21:1452–1458

    Article  PubMed  Google Scholar 

  11. US Renal Data System (2003) USRDS 2003 Annual Data Report. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD

  12. Allon M, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne DW, Depner TA, Gassman JJ, Kaufman AM, Kaysen GA, Lewis JA, Schwab SJ (2005) HEMO Study Group: The spectrum of infection-related morbidity in hospitalized hemodialysis patients. Nephrol Dial Transplant 20:1180–1186

    Article  PubMed  Google Scholar 

  13. Beathard GA (1999) Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 10:1045–1049

    PubMed  CAS  Google Scholar 

  14. Saad TF (1999) Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis 34:1114–1124

    PubMed  CAS  Google Scholar 

  15. Goldstein SL, Macierowski CT, Jabs K (1997) Hemodialysis catheter survival and complications in children and adolescents. Pediatr Nephrol 11:74–77

    Article  PubMed  CAS  Google Scholar 

  16. Sharma A, Zilleruelo G, Abitbol C, Montane B, Strauss J (1999) Survival and complications of cuffed central venous catheters in children and young adults on chronic hemodialysis. Pediatr Nephrol 13:245–248

    Article  PubMed  CAS  Google Scholar 

  17. Paglialonga F, Esposito S, Edefonti A, Principi N (2004) Catheter-related infections in children treated with hemodialysis. Pediatr Nephrol 19:1324–1333

    Article  PubMed  Google Scholar 

  18. Powe NR, Jaar B, Furth SL (1999) Septicemia in dialysis patients: incidence, risk factors and prognosis. Kidney Int 55:1081–1090

    Article  PubMed  CAS  Google Scholar 

  19. Beathard GA (2003) Catheter management protocol for catheter-related bacteremia prophylaxis. Semin Dial 16:403–405

    Article  PubMed  Google Scholar 

  20. Kovalik EC, Raymond JR, Albers FJ, Berkoben M, Butterfly DW, Montella B, Conlon PJ (1996) A clustering of epidural abscesses in chronic hemodialysis patients: Risk of salvaging access catheters in cases of infection. J Am Soc Nephrol 7:2264–2267

    PubMed  CAS  Google Scholar 

  21. Marr KA, Schwab SJ, Sexton D, Conlon P (1997) Bacteremia in patients with central venous catheters used for hemodialysis: Lack of evidence of catheter salvage. Ann Intern Med 127:275–280

    PubMed  CAS  Google Scholar 

  22. Shroff GR, Herzog CA, Ma JZ, Collins AJ (2004) Long-term survival of dialysis patients with bacterial endocarditis in the United States. Am J Kidney Dis 44:1077–1082

    Article  PubMed  Google Scholar 

  23. Passerini L, Lam K, Costerton JW, King EG (1992) Biofilms on indwelling vascular catheters. Crit Care Med 20:665–673

    Article  PubMed  CAS  Google Scholar 

  24. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaisse E, Bodey GP (1993) Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 168:400–407

    PubMed  CAS  Google Scholar 

  25. Costerton JW, Stewart PS, Greenberg EP (1999) Bacterial biofilms: A common cause of persistent infections. Science 284:1318–1322

    Article  PubMed  CAS  Google Scholar 

  26. Messing B, Peitra-Cohen S, Debure A, Beliah M, Bernier JJ (1988) Antibiotic-lock technique: A new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. JPEN J Parenter Enteral Nutr 12:185–189

    Article  PubMed  CAS  Google Scholar 

  27. Messing B, Man F, Colimon R, Thuillier F, Beliah M (1990) Antibiotic-lock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition. Clin Nutr 9:220–225

    Article  PubMed  CAS  Google Scholar 

  28. Bailey E, Berry N, Cheesbrough JS (2002) Antimicrobial lock therapy for catheter-related bacteremia among patients on maintenance hemodialysis. J Antimicrob Chemother 50:615–617

    Article  PubMed  CAS  Google Scholar 

  29. Capdevilla JA, Segarra A, Planes AM, Ramirez-Arellano M, Pahissa A, Piera L, Martinez-Vazquez JM (1993) Successful treatment of haemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant 8:231–234

    Google Scholar 

  30. Krishnasami Z, Carlton D, Bimbo L, Taylor ME, Balkovetz DF, Barker J, Allon M (2002) Management of hemodialysis catheter-related bacteremia with an adjunctive lock solution. Kidney Int 61:1136–1142

    Article  PubMed  Google Scholar 

  31. Poole CV, Carlton D, Bimbo L, Allon M (2004) Treatment of catheter-related bacteremia with an antibiotic lock protocol: effect of bacterial pathogen. Nephrol Dial Transplant 19:1237–1244

    Article  PubMed  CAS  Google Scholar 

  32. Rijnders BJ, Wijngaerden EV, Vandecasteele SJ, Stas M, Peetermans WE (2005) Treatment of long-term intravascular catheter-related bacteremia with antibiotic lock: randomized, placebo-controlled trial. J Antimicrob Chemother 55:90–94

    Article  PubMed  CAS  Google Scholar 

  33. Fernandez-Hidalgo N, Almirante B, Calleja R, Ruiz I, Planes AM, Rodriguez D, Pigrau C, Pahissa A (2006) Antibiotic-lock therapy for long-term intravascular catheter-related bacteremia: Results of an open, non-comparative study. J Antimicrob Chemother 57:1172–1180

    Article  PubMed  CAS  Google Scholar 

  34. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Healthcare infection control practices advisory committee: guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 30:476–489

    Article  PubMed  Google Scholar 

  35. Haimi-Cohen Y, Husain N, Meenan J, Karayalcin G, Lehrer M, Rubin LG (2001) Vancomycin and ceftazidime bioactivities persist for at least 2 weeks in the lumen in ports: simplifying treatment of port-associated bloodstream infections by using the antibiotic lock technique. Antimicrob Agents Chemother 45:1565–1567

    Article  PubMed  CAS  Google Scholar 

  36. Anthony TU, Rubin LG (1999) Stability of antibiotics used for antibiotic-lock treatment of infections of implantable venous devices (ports). Antimicrob Agents Chemother 43:2074–2076

    PubMed  CAS  Google Scholar 

  37. Shanks RM, Sargent JL, Martinez RM, Graber ML, O’Toole GA (2006) Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces. Nephrol Dial Transplant 21:2247–2255

    Article  PubMed  CAS  Google Scholar 

  38. Bamgbola OF, del Rio M, Kaskel FJ, Flynn JT (2005) Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance. Pediatr Nephrol 20:989–993

    Article  PubMed  Google Scholar 

  39. Rijnders BJ, Van Wijngaerden E, Van Eldere J, Peetermans WE (2001) Polyclonal Staphylococcus epidermidis intravascular catheter-related infections. Clin Microbiol Infect 7:388–391

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Nephrology, West Virginia University/ Health Sciences Center, P.O. Box 9214, Morgantown, WV, 26506-9214, USA

    Ali Mirza Onder

  2. Department of Pediatrics, Division of Pediatric Nephrology, University of Miami / Holtz Children’s Hospital, Miller School of Medicine, Miami, FL, USA

    Jayanthi Chandar, Marie Saint-Vil, Denise Francoeur, Obioma Nwobi, Carolyn Abitbol & Gaston Zilleruelo

  3. Department of Pharmacy, Pediatric Pharmacy, University of Miami / Holtz Children’s Hospital, Miami, FL, USA

    Nancy Simon

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  1. Ali Mirza Onder
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  2. Jayanthi Chandar
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  3. Nancy Simon
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  4. Marie Saint-Vil
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  8. Gaston Zilleruelo
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Correspondence to Ali Mirza Onder.

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Onder, A.M., Chandar, J., Simon, N. et al. Treatment of catheter-related bacteremia with tissue plasminogen activator antibiotic locks. Pediatr Nephrol 23, 457–464 (2008). https://doi.org/10.1007/s00467-007-0687-8

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  • DOI: https://doi.org/10.1007/s00467-007-0687-8

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