Beigi Ali Akbar, Khansoltani Sahar, Masoudpour Hassan, Atapour Abdol Amir, Eshaghian Afrooz, Khademi Elham Fatemeh
Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Saudi J Kidney Dis Transpl. 2010 Jan;21(1):54-8.
Infection of permanent catheters (Permcath) in hemodialysis (HD) patients can lead to catheter removal. The successful use of an antibiotic-lock to treat infection has reported good results in the treatment of catheters' infections. This study was designed to evaluate the impact of the intraluminal vancomycin in comparison with intravenous antibiotic administration. We included 67 (37 males and 30 females) chronic HD patients requiring Permcath insertion at our tertiary care hospital from July 2004 to June 2007. We studied two subgroups: an intervention group, which received 500 mg vancomycin infusion via both lumens of the Permcath and antibiotic lock of 1.5 mL each 48 hours with 1 g i.v. ceftriaxone every 12 hours for 7 days, followed by oral antibiotics according to the culture for three weeks; and a control group, which received 500 mg intravenous vancomycin with daily 100-150 mg amikacin intravenously. Our endpoint was the rate of catheter removal. The patients characteristics including age, sex, time of insertion of the catheter and number of dialysis sessions per week did not differ between both subgroups. Of 28 patients in the intervention group, there was one catheter removal, and of 39 patients in the control group, there were 22 catheter removals, (P< 0.001). We conclude that administration of vancomycin as an antibiotic-lock in permcaths is more effective than its mere intravenous injection, and can increase the life span of catheters.
血液透析（HD）患者的长期导管（Permcath）感染可导致导管拔除。抗生素封管法成功用于治疗感染，在导管感染治疗中已报道取得良好效果。本研究旨在评估腔内注射万古霉素与静脉使用抗生素相比的效果。我们纳入了2004年7月至2007年6月期间在我们三级护理医院需要插入Permcath的67例（37例男性和30例女性）慢性HD患者。我们研究了两个亚组：干预组，通过Permcath的两个腔注入500mg万古霉素，并每48小时进行1.5mL抗生素封管，同时每12小时静脉注射1g头孢曲松，共7天，之后根据培养结果口服抗生素3周；对照组，静脉注射500mg万古霉素，每日静脉注射100 - 150mg阿米卡星。我们的终点是导管拔除率。两个亚组患者的特征，包括年龄、性别、导管插入时间和每周透析次数均无差异。干预组的28例患者中有1例导管拔除，对照组的39例患者中有22例导管拔除，（P < 0.001）。我们得出结论，在Permcath中使用万古霉素进行抗生素封管比单纯静脉注射更有效，并且可以延长导管使用寿命。
