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Prophylaxis of catheter-related bacteremia using tissue plasminogen activator–tobramycin locks

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Abstract

This retrospective study was designed to investigate the effectiveness of tissue plasminogen activator–tobramycin antibiotic lock solutions (TPA/tobra ABLs) for prophylaxis of catheter-related bacteremia (CRB) in high-risk children on long-term hemodialysis. During the first 6 months (Era 1), the high-risk group was defined. These patients received TPA/tobra ABL prophylaxis after every hemodialysis treatment for the next 6 months (Era 2). The prophylaxis regimen was applied once a week for the third 6-months period (Era 3). Primary endpoints were CRB and infection-free catheter survival. There were 16,412 catheter days, and 95 cases of CRB in 43 children. The incidence of CRB was 5.8/1,000 catheter days. Significant decrease in the incidence of CRB was observed when prophylactic TPA/tobra ABL was used in the high-risk group (P = 0.0201). There was a tendency for less CRB when prophylactic ABL was applied after every hemodialysis session compared with once a week (P = 0.0947). The catheters in the high-risk group had shorter survival times than those in the average-risk group in Era 1 (P < 0.0001). However, both the overall and infection-free survival of the catheters in the high-risk group significantly improved while the patients were receiving TPA/tobra ABL prophylaxis, becoming similar to the outcomes of the catheters in the average-risk group and exhibiting statistically non-significant differences (P = 0.5571 and P = 0.9711, respectively). In conclusion, the TPA/tobra ABLs may effectively reduce the rate of CRB, and this may prolong both the overall and infection-free survival times of the catheters in the high-risk group.

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Abbreviations

ABL:

Antibiotic lock solution

AV:

Arteriovenous

CRB:

Catheter-related bacteremia

ESI:

Exit site infection

GN:

Glomerulonephritis

HIV:

Human immunodeficiency virus

IRB:

Institutional Review Board

K/DOQI:

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative

MIC:

Minimal inhibitory concentration

NA:

Not applicable

NS:

Not significant

SD:

Standard deviation

TCC:

Tunneled-cuffed central venous catheter

TPA:

Tissue plasminogen activator

TPA/tobra:

Tissue plasminogen activator/tobramycin

URR:

Urea reduction ratio

WGE:

Wire-guided exchange of a catheter

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Acknowledgments

This study was presented in part at Renal Week 2006 in San Diego, California, USA, 14–19 November 2006, and at the 14th Congress of the International Pediatric Nephrology Association (IPNA) in Budapest, Hungary, 31 August–4 September 2007.

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Authors and Affiliations

  1. Pediatrics, West Virginia University, WVU/HSC, P. O. Box 9214, Morgantown, WV 26506-9214, USA

    Ali Mirza Onder

  2. Pediatrics, University of Miami, 1611 NW 12th Avenue, Annex 5, Miami, Florida, 33136, USA

    Jayanthi Chandar, Nancy Simon, JoAnn Gonzalez, Denise Francoeur, Carolyn Abitbol & Gaston Zilleruelo

  3. Statistics, West Virginia University, Morgantown, West Virginia, USA

    Anthony Billings

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  1. Ali Mirza Onder
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  2. Jayanthi Chandar
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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., Billings, A. et al. Prophylaxis of catheter-related bacteremia using tissue plasminogen activator–tobramycin locks. Pediatr Nephrol 24, 2233–2243 (2009). https://doi.org/10.1007/s00467-009-1235-5

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  • DOI: https://doi.org/10.1007/s00467-009-1235-5

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