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Clin J Am Soc Nephrol. 2008 Jul;3(4):1048-56. doi: 10.2215/CJN.04931107. Epub 2008 Apr 9.

Comparison of early versus late use of antibiotic locks in the treatment of catheter-related bacteremia.

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  • 1Division of Pediatric Nephrology, West Virginia University/Health Sciences Center, P.O. Box 9214, Morgantown, WV 26506-9214, USA. aonder@hsc.wvu.edu

Abstract

BACKGROUND AND OBJECTIVES:

This retrospective study compared the effectiveness of the timing of the antibiotic locks to clear catheter-related bacteremia in children on chronic hemodialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The early antibiotic lock group received antibiotic locks along with systemic antibiotics from the very beginning of catheter-related bacteremia. The late antibiotic lock group was given only systemic antibiotics initially, and antibiotic locks were used late in the infection if the catheter-related bacteremia could not be cleared after resolution of symptoms.

RESULTS:

There were 264 catheter-related bacteremias in 79 children during 6 yr of observation. Early antibiotic locks were able to clear catheter-related bacteremia and resolve the symptoms more effectively without the need for catheter exchange when compared with late antibiotic locks. A total of 84 catheter-related bacteremias required wire-guided exchange of the catheters. Late antibiotic locks required wire-guided catheter exchange more frequently than the early antibiotic locks. The post-catheter-related bacteremia infection-free survival of the catheters after wire-guided exchange were significantly longer than those of both antibiotic lock groups. Recurrence of catheter-related bacteremia within 45 d after wire-guided exchange occurred at similar rates compared with the antibiotic lock groups.

CONCLUSION:

Antibiotic locks are significantly more effective in clearing catheter-related bacteremia when used early in infection, diminishing the need for catheter exchange. Wire-guided exchange has a late-onset advantage for infection-free survival compared with catheter in situ treatment. The recurrence rates in the first 45 d after catheter-related bacteremia are similar regardless of the treatment strategy.

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