Justo Julie Ann, Bookstaver P Brandon
Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA.
Infect Drug Resist. 2014 Dec 12;7:343-63. doi: 10.2147/IDR.S51388. eCollection 2014.
Antibiotic lock therapy (ALT) for the prevention and treatment of catheter-related bloodstream infections is a simple strategy in theory, yet its real-world application may be delayed or avoided due to technical questions and/or logistical challenges. This review focuses on these latter aspects of ALT, including preparation information for a variety of antibiotic lock solutions (ie, aminoglycosides, beta-lactams, fluoroquinolones, folate antagonists, glycopeptides, glycylcyclines, lipopeptides, oxazolidinones, polymyxins, and tetracyclines) and common clinical issues surrounding ALT administration. Detailed data regarding concentrations, additives, stability/compatibility, and dwell times are summarized. Logistical challenges such as lock preparation procedures, use of additives (eg, heparin, citrate, or ethylenediaminetetraacetic acid), timing of initiation and therapy duration, optimal dwell time and catheter accessibility, and risks of ALT are also described. Development of local protocols is recommended in order to avoid these potential barriers and encourage utilization of ALT where appropriate.
抗生素封管疗法（ALT）用于预防和治疗导管相关血流感染，从理论上讲是一种简单的策略，但由于技术问题和/或后勤挑战，其在实际应用中可能会延迟或被避免。本综述聚焦于ALT的这些后期方面，包括各种抗生素封管溶液（即氨基糖苷类、β-内酰胺类、氟喹诺酮类、叶酸拮抗剂、糖肽类、甘氨酰环素类、脂肽类、恶唑烷酮类、多粘菌素类和四环素类）的配制信息以及ALT给药过程中常见的临床问题。总结了关于浓度、添加剂、稳定性/相容性和封管时间的详细数据。还描述了后勤挑战，如封管配制程序、添加剂（如肝素、柠檬酸盐或乙二胺四乙酸）的使用、开始时间和治疗持续时间、最佳封管时间和导管可及性以及ALT的风险。建议制定当地方案，以避免这些潜在障碍，并在适当情况下鼓励使用ALT。
