Introduction:
Catheter related blood stream infection (CRBSI) is the most dreaded complication of tunneled dialysis catheter. IDSA guidelines recommend, Systemic antibiotics and antibiotic lock as the standard of care for CRBSI management. It is recommended to remove catheter if the offending organism is staphylococcus, Pseudomonas or fungus.
Present study compared 70% alcohol lock with antibiotic lock as treatment strategy for CRBSI.
Methods:
The study is a prospective study of two dialysis centers over last 5 years. All patients with TCC were followed up for CRBSI. Diagnosis of CRBSI was based on CDC/IDSA criteria. All patients with CRBSI were treated with broad spectrum systemic antibiotics. In addition to systemic antibiotics, in one group antibiotic lock while in other group 70% alcohol lock was used for 3 days. Outcome of two groups was compared.
Results:
Over 5-year period 431 tunneled catheters were inserted in 371 patients. 291 catheters, with a minimum follow up of 30 days were followed up. Total follow up duration was 48778 days with mean follow- up period of 167.04+ 185.32 days (range 30-1100 days). We encountered 78 episodes of CRBSI (1.6 per 1000 catheter days). CRBSI occurred after a mean follow up of 169 + 177.80 days.
Fifteen of the 22 catheters treated with systemic antibiotics and antibiotic lock (68%) required removal while only 6 of the fifty- six catheters (10.7%) managed with 70% alcohol lock, required removal [ p<0.001). Majority of infections, 73% (57/78), were caused by gram negative organisms. Age, Sex and presence of DM were not found to be risk factors for CRBSI (p> 0.05). During a follow up of 145 days, there was no incidence of catheter leak or dysfunction.
Conclusions:
Alcohol lock is safe and appears superior to antibiotic lock for catheter salvage, in CRBSI.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.