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Antimicrobial Lock Therapy as an Adjunct to Management of Catheter-Related Bacteremia: A Community Hospital Experience

Tejwani, Rohit MD*; Parry, Michael F. MD†

Infectious Diseases in Clinical Practice: July 2011 - Volume 19 - Issue 4 - pp 256-261
doi: 10.1097/IPC.0b013e31820a5443
Original Articles

Background: Episodes of central venous catheter-related bacteremia (CVCB) have become common events in patients with long-term indwelling central venous catheters. Because no standardized treatment for CVCB exists, novel approaches have been used to salvage catheters where vascular access is limited. Use of antibiotic solutions to fill catheter lumens has been shown to prevent CVCB and may be useful for the treatment of already-infected catheters.

Methods: We retrospectively examined patient records over a 10-year period at a 300-bed community hospital to evaluate the effectiveness of antibiotic lock therapy (ALT) for catheter salvage in patients experiencing CVCB to determine what criteria might be useful for clinicians deciding between ALT and device removal.

Results: Of 458 episodes of CVCB, ALT was attempted in 116 cases (25.3%). Of these, successful salvage was achieved in 86 cases (74.1%), whereas 30 attempts at salvage (25.9%) failed. Average duration of treatment was 13.4 days. Treatment effectiveness varied based on infecting organism, ranging from 78.9% (15/19) for gram-negative bacilli to 42.8% (9/21) for Staphylococcus aureus. The success of antimicrobial lock therapy was independent of patient age or sex, underlying disease, comorbidity, or catheter type. It was most dependent on the infecting organism and the availability of an appropriate antimicrobial agent to treat it.

Conclusions: Antibiotic lock therapy is a useful, although not universally applicable, treatment for CVCB allowing successful catheter salvage in up to 75% of cases without requiring catheter removal and replacement.

From the *Division of Infectious Diseases, Stamford Hospital, Stamford, CT; and †Columbia University College of Physician and Surgeons, New York, NY.

Correspondence to: Michael F. Parry, MD, Stamford Hospital, 30 Shelburne Rd, Stamford, CT 06902. E-mail: mparry@stamhealth.org.

The authors have no funding or conflicts of interest to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.