COMBATING HEMODIALYSIS CATHETER-RELATED INFECTION USING AN ANTIBIOTIC LOCK, ACASE-CONTROL STUDY, AT KING FAHD HOSPITAL OF THE UNIVERSITY, SAUDI ARABIA

Background: Catheter-related infections (CRI) in hemodialysis patients are very common complications with devastating consequences if not managed appropriately, as most of the morbidity and mortality among these patients are caused by bacteremia related to hemodialysis. Hence, safety issues exist to restrict the spread of infections among this group of patients. A prophylactic technique that is worth of much discussion is the use of antimicrobial lock solutions (ALS). Several studies have been conducted in this area. Yet, there is no consensus recommendation in this regarding. Hence, the purpose of our study is to examine the efficacy of ALS for prevention of CRI in patients undergoing HD. Methodology: Methods:A total of 86 TCC in 69 HD patients were enrolled at the time of catheter insertion for delivering HD. Patients were randomized into two groups: Group I (36 patients-39 insertions) included TCC with antibiotic-lock therapy and Group II (33 patients-47 insertions) with routine TCC management. Infection-free catheter survi­val of both groups was evaluated and compared at the end of the 7-month study period. Results:A total of 67 TCC-related infections were detected, with an incidence rate of 8.79/1000 dialysis sessions (ds). Out of these infections, 50 belonged to patients in group II with an incidence rate of 12.88/1000 ds, and 17 in patients of group I with an incidence rate of 4.51/1000 ds (p<0.001) (Table 3). The bacteremia rate was 5.14/1000 ds in patients of group II and only 0.63/1000 ds in patients of group I (p<0.001). Clinical sepsis occurred in 19 (28.4%) of the 67 TCC infections. Clinical sepsis rate was significantly lower in patients of group I (0.61/1000ds) compared with 4.12/1000 ds in group II patients (p<0.005). Conclusion: TCC lock with vancomycin and gentamycin appears to be highly effective strategy for the reduction of morbidity, and potentially mortality and costs, associated with TCC-related bacterial infections in HD patients. In this study, this protocol was free of side effects.