Gang Sishir, Konnur Abhijit, Rajapurkar Mohan, Hegde Umapati, Patel Hardik, Patel Jigar, Shete Nitiraj
Department of Nephrology, Muljibhai Patel Urological Hospital Nadiad, India.
Department of Biostatistics, Muljibhai Patel Urological Hospital Nadiad, India.
J Vasc Access. 2024 Jul;25(4):1100-1107. doi: 10.1177/11297298221149477. Epub 2023 Jan 11.
Catheter-Related Blood Stream Infection (CRBSI) is the major limitation of using Tunneled cuffed catheter (TCC) for long-term Hemodialysis. The standard therapy of CRBSI involves systemic antibiotics with catheter replacement/removal. As antibiotic alone is rarely effective therapy for CRBSI, biofilm eradication using antimicrobial locking solutions is a promising modality for CRBSI treatment, hence catheter salvage. The present study evaluated the efficacy and safety of Ethanol-lock therapy (ELT) in combination with systemic antibiotics for the management of CRBSI associated with hemodialysis TCC.
56 patients with CRBSI were treated with 70% ELT (1 h daily for 5 days) along with systemic antibiotics. Seventeen patients with CRBSI who didn't consent to ELT were treated with antibiotics alone. The effect of ELT was evaluated as clinical cure (fever resolution and negative surveillance cultures), infection-free TCC survival duration and adverse events of ELT among patients with CRBSI. The parameters were compared with 17 patients treated with antibiotics alone.
ELT was successful in 50 out of 56 patients (89.28%); compared to 41.17% (seven out of 17) with antibiotics alone ( < 0.001). Mean TCC survival was also significantly higher with ELT combined with systemic antibiotics (126.23 ± 18.67 days) compared to antibiotics alone (38.76 ± 9.91) ( = 0.006). No systemic adverse effects were noted with ELT; two patients receiving ELT had catheter breakage during the study period.
We conclude that short-dwell daily ELT with systemic antibiotics is an effective therapy for CRBSI in hemodialysis patients with TCC.
导管相关血流感染（CRBSI）是长期使用带隧道带涤纶套导管（TCC）进行血液透析的主要限制因素。CRBSI的标准治疗方法包括全身使用抗生素并更换/拔除导管。由于单独使用抗生素对CRBSI很少有有效的治疗效果，使用抗菌封管液消除生物膜是一种很有前景的CRBSI治疗方式，从而可挽救导管。本研究评估了乙醇封管疗法（ELT）联合全身抗生素治疗与血液透析TCC相关的CRBSI的疗效和安全性。
56例CRBSI患者接受70%乙醇封管疗法（每天1小时，共5天）并联合全身抗生素治疗。17例不同意接受乙醇封管疗法的CRBSI患者仅接受抗生素治疗。评估乙醇封管疗法的效果，包括临床治愈（发热消退且监测培养结果为阴性）、无感染的TCC存活时间以及CRBSI患者中乙醇封管疗法的不良事件。将这些参数与17例仅接受抗生素治疗的患者进行比较。
56例患者中有50例（89.28%）乙醇封管疗法治疗成功；相比之下，仅使用抗生素治疗的成功率为41.17%（17例中有7例）（P<0.001）。与仅使用抗生素治疗相比，乙醇封管疗法联合全身抗生素治疗的平均TCC存活时间也显著更长（126.23±18.67天）（仅使用抗生素治疗为38.76±9.91天）（P=0.006）。乙醇封管疗法未观察到全身不良反应；两名接受乙醇封管疗法的患者在研究期间出现导管破裂。
我们得出结论，短期每日乙醇封管疗法联合全身抗生素是治疗TCC血液透析患者CRBSI的有效疗法。
