El Nekidy Wasim S, Soong Derrick, Kadri Albert, Tabbara Osama, Ibrahim Amina, Ghazi Islam M
Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada.
Case Rep Nephrol Dial. 2018 Jul 25;8(2):121-129. doi: 10.1159/000489923. eCollection 2018 May-Aug.
Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.
导管相关血流感染是血液透析患者的一个主要问题，会导致死亡率、发病率上升以及治疗成本增加。及时进行适当的全身抗生素治疗是必要的，这包括给予适当的全身抗生素，并且通常还需要拔除和更换导管。然而，在血液透析患者中，反复插入导管可能会导致中心静脉狭窄和血栓形成，从而限制了未来进行血液透析通路的可能性。含抗生素和抗凝剂的封管溶液在每次透析后直接注入导管腔，已成功用于挽救导管，但在由葡萄球菌引起的感染中观察到复发率和并发症发生率较高。我们报告了几例使用抗生素封管溶液挽救葡萄球菌血症患者导管的病例，目的是激发对随机临床试验的兴趣。鉴于优化的全身抗生素给药、改进的封管溶液使用以及多学科参与，同时权衡预防不必要血管创伤的迫切需求，评估该患者亚组中挽救导管的风险和益处非常重要。
