Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Hong Kong Med J. 2010 Aug;16(4):269-74.
To investigate the effect of antibiotic lock solutions for preventing catheter-related bacteraemia in patients receiving haemodialysis.
Retrospective study.
University teaching hospital, Hong Kong.
Consecutive patients from March 2006 to April 2007 who had central venous catheter insertion for haemodialysis in our centre were included in this historically controlled study. In all, 75 patients had catheters with heparin solution alone and 74 had catheters with a gentamicin antibiotic lock. The majority of catheters were non-tunnelled (95%). Cumulative catheter survival free of catheter-related bacteraemia in the two groups was compared.
Baseline characteristics in the two groups were similar apart from a slightly lower serum albumin level in those with gentamicin locks. There were 18 and five catheter-related bacteraemia episodes before and after recourse to gentamicin antibiotic locks, respectively. Staphylococcus aureus contributed to over half (65%) of the total bacteraemia episodes. Use of gentamicin antibiotic locks significantly reduced catheter-related bacteraemia episodes per 1000 catheter days from 4.6 to 1.5 (P=0.002). Kaplan-Meier survival analysis using the log rank test showed significantly better bloodstream infection-free survival associated with using gentamicin antibiotic locks (P=0.032). A similar survival advantage was associated with gentamicin antibiotic locks when the analysis was restricted to non-tunnelled catheters. There was no significant association of catheter-related bacteraemia with patient age, obesity, gender, baseline serum albumin level, or diabetes mellitus. No serious adverse events were attributable to the use of gentamicin antibiotic locks.
Use of gentamicin lock solutions effectively reduced catheter-related bacteraemia in haemodialysis patients, including those with non-tunnelled catheters.
研究抗生素封管液预防血液透析患者导管相关性菌血症的效果。
回顾性研究。
香港一所大学教学医院。
本历史对照研究纳入 2006 年 3 月至 2007 年 4 月在我院接受中心静脉置管进行血液透析的连续患者。共有 75 例患者的导管中单独使用肝素溶液，74 例患者的导管中使用庆大霉素抗生素封管液。大多数导管为非隧道式（95%）。比较两组无导管相关性菌血症的导管累计生存率。
两组患者的基线特征相似，但使用庆大霉素封管液的患者血清白蛋白水平略低。在使用庆大霉素抗生素封管液之前和之后，分别有 18 例和 5 例导管相关性菌血症病例。金黄色葡萄球菌导致的菌血症占总菌血症的一半以上（65%）。使用庆大霉素抗生素封管液后，每千导管日导管相关性菌血症的发生率从 4.6 例降至 1.5 例（P=0.002）。对数秩检验的 Kaplan-Meier 生存分析显示，使用庆大霉素抗生素封管液与无血流感染的生存显著相关（P=0.032）。当分析仅限于非隧道式导管时，庆大霉素抗生素封管液也与生存优势相关。导管相关性菌血症与患者年龄、肥胖、性别、基线血清白蛋白水平或糖尿病无显著相关性。使用庆大霉素抗生素封管液没有发生严重不良事件。
在血液透析患者中，包括非隧道式导管患者，使用庆大霉素封管液可有效降低导管相关性菌血症的发生率。
