Publication: Antibiotic lock therapy (ALT) for management of catheter-related infection in Hospital Universiti Sains Malaysia (HUSM
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Date
2022
Authors
Azmi, Nur Ain Che
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Abstract
Introduction: Central venous catheters (CVCs) are used widely in hospitals, especially in critically ill patients, haemodialysis, and oncology patients. Despite all the excellent usage and proper infection control practices, infections remain the most common complications of such devices. In some conditions with limited vascular access, clinicians may attempt a few ways to salvage the catheter. Antibiotic lock therapy (ALT), designed to achieve 100 to 1000-fold minimum inhibitory concentrations (MICs) in the lumen, has been proposed to tackle the issue of biofilm in such pathogens. The association between the use of ALT and the outcome of a catheter-related infection (CRI) will help us justify the use of ALT in catheter-related infections. Furthermore, the overall success rate found in each pathogen causing the infection may also help clinicians choose the appropriate ALT modalities. Materials and method: This was a retrospective record review involving patients with catheter-related infections diagnosed by treating clinicians in Hospital Universiti Sains Malaysia (HUSM) from January 2016 to December 2019. A total of 120 cases suitable for ALT were selected for this study. ALT can be given to those with uncomplicated CRBSI or catheter colonisation in which the CVCs were intended to be salvaged for various reasons. Out of this, only 53 cases were taken into the analysis as those that retained the CVCs after treatment either by systemic antibiotic alone or by both systemic antibiotic and ALT. All the data that has been collected were analysed using version 27 of the SPSS software (SPSS Inc, Chicago, IL). Results: Out of 53 cases of CRI, only 36 (67.9%) cases were given ALT together with systemic antibiotics by the treating clinicians. Most cases (86.1%) were from oncological wards where patients with haematological malignancy were the most common proportion of patients receiving ALT. Methicillin-resistant coagulase-negative staphylococci (MRCONS) were found to be the most common pathogens causing CRI and were given ALT with a success rate of 82.4%. Among the CRI cases that were given a combination treatment of systemic antibiotics and ALT, there was a significant reduction in CRP levels up to 42% (p=0.001), and about 83.3% were able to salvage the catheter (p<0.001). Conclusion: A combination of antibiotic lock therapy together with systemic antibiotic treatment may be an effective strategy for salvaging the catheter. Further studies may be required to determine the effectiveness of ALT in specific populations of patients.
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Keywords
Catheter-related infection , antibiotic lock therapy