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Comparison of Early versus Late Use of Antibiotic Locks in the Treatment of Catheter-Related Bacteremia

Ali Mirza Onder^*, Jayanthi Chandar, A. A. Billings, Nancy Simon, Rosa Diaz, Denise Francoeur, Carolyn Abitbol, and Gaston Zilleruelo

^* Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, and Department of Statistics, West Virginia University, Morgantown, West Virginia; and Department of Pediatrics, Division of Pediatric Nephrology, and Department of Pharmacy, Pediatric Pharmacy, University of Miami/Holtz Children's Hospital, Miami, Florida

Correspondence: Dr. Ali Mirza Onder, West Virginia University/Health Sciences Center, Division of Pediatric Nephrology, P.O. Box 9214, Morgantown, WV 26506-9214. Phone: 304-293-1213; Fax: 304-293-1216; E-mail: aonder{at}hsc.wvu.edu

Background and objectives: This retrospective study compared the effectiveness of the timing of the antibiotic locks to clear catheter-related bacteremia in children on chronic hemodialysis.

Design, setting, participants, & measurements: The early antibiotic lock group received antibiotic locks along with systemic antibiotics from the very beginning of catheter-related bacteremia. The late antibiotic lock group was given only systemic antibiotics initially, and antibiotic locks were used late in the infection if the catheter-related bacteremia could not be cleared after resolution of symptoms.

Results: There were 264 catheter-related bacteremias in 79 children during 6 yr of observation. Early antibiotic locks were able to clear catheter-related bacteremia and resolve the symptoms more effectively without the need for catheter exchange when compared with late antibiotic locks. A total of 84 catheter-related bacteremias required wire-guided exchange of the catheters. Late antibiotic locks required wire-guided catheter exchange more frequently than the early antibiotic locks. The post–catheter-related bacteremia infection–free survival of the catheters after wire-guided exchange were significantly longer than those of both antibiotic lock groups. Recurrence of catheter-related bacteremia within 45 d after wire-guided exchange occurred at similar rates compared with the antibiotic lock groups.

Conclusion: Antibiotic locks are significantly more effective in clearing catheter-related bacteremia when used early in infection, diminishing the need for catheter exchange. Wire-guided exchange has a late-onset advantage for infection-free survival compared with catheter in situ treatment. The recurrence rates in the first 45 d after catheter-related bacteremia are similar regardless of the treatment strategy.