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Identifier

000375339

Title

Η χρήση της λινεζολίδης ως διαλύματος παγίδευσης κεντρικών φλεβικών καθετήρων για την πρόληψη των σχετιζόμενων με αυτούς λοιμώξεων στους αιμοκαθαιρόμενους ασθενείς : Μια προοπτική τυχαιοποιημένη μελέτη

Alternative Title

The use of linezolid antibiotic lock solution for the prevention of catheter related blood stream infections in hemodialysis patients :

Author

Σωφρονιάδου, Σοφία

Thesis advisor

Σαμώνης, Γ.

Reviewer

Γκίκας, Α.
Δαφνής, Ε.
Μαυρουδής, Δ.
Παπαδάκη, Ε.
Αγγελάκη, Σ.
Κοφτερίδης, Δ.

Abstract

Introduction: Catheter related blood stream infection (CRBSI) in hemodialysis patients is the most serious complication associated with the use of central venous catheters either non-tunneled (NTC) or tunnelled (TCC) that can result in life –threatening conditions and substantial morbidity, mortality and increased cost of medical care. From a number of strategies utilized to reduce the incidence of CRBSI the instillation of an antibiotic lock solution (ALS) to the lumens of the hemodialysis (HD) catheter in between each HD session (antibiotic lock technique-ALT) seems to be promising and effective. Purpose of the study: To assess the efficacy and safety of linezolid (the first oxazolidinone antimicrobial agent with a wide spectrum of activity against almost all gram-positive organisms including pathogens resistant to methicillin and vancomycin) as an ALS for the prevention of CRBSI in HD patients. Linezolid ALS was also compared with three other lock solutions containing heparin, vancomycin and ethanol. Materials and Methods: In a randomized prospective single centre study patients with end stage chronic kidney disease that received an non-tunneled HD catheter exclusively for HD were randomized to receive a lock solution with either a) unfractionated heparin 2000U/ml b) vancomycin 5mg/ml+ unfractionated heparin 2000U/ml c) linezolid 2 22 mg/ml + unfractionated heparin 2000U/ml and d) ethanol 70%+ unfractionated heparin 2000U/ml. The primary end point of the study was CRBSI whereas exit site infections bacterial colonization, thrombosis and bleeding episodes were the secondary end points. Results: A total of 204 NTCs-118 in jugular, 72 in subclavian and 14 in femoral vein -were inserted in 181 HD patients between 12/2004 and 06/2008. Fifty one catheters were randomized to group A, 49 to group B and 52 catheters to group C and 52 to group D. There were no significant differences in patient and catheter characteristics on inclusion. Median number of catheter days was greater in group C (median=38, range: 32-42) compared to group A (median 34, range: 23-39) to group B (median=36, range: 35-43) and to group D (median 32, range: 27-40) (p<0.001). The linezolid-locked group did not present any infective episode (0/1000 catheter-days) compared to 2 episodes in the vancomycin-locked group (1.21/1000 catheter-days, p=0.1021), 11 episodes in the heparin alone group (6.7/1000 catheter-days, p=0.0001) and 4 episodes in the ethanol group (2.53/1000 catheter-days p=0.0191). The vast majority of the cultures from the patients that presented CRBSI yielded Gram-positive microorganisms, predominantly S. epidermidis and S. aureus. No death attributed to CRBSI was recorded. No significant differences were demonstrated between the 3 groups regarding the secondary end points of the study. No side effects were recorded with the use of linezolid ALS whereas 6 group D patients 23 demonstrated perioral dysesthesia or metallic taste of very short duration after locking with ethanol. During the two year follow up period one case of vancomycin resistance enterococcus was isolated in a group B patient. Conclusion: Linezolid is a safe and effective choice as an ALS preventing CRBSI and prolonging the survival of the catheter in HD patients. When compared to the other lock solutions it is superior towards heparin and ethanol lock solutions and equal to vancomycin ALS regarding the prevention of CRBSI in HD patients.

Language

Greek

Subject

Antibiotic lock solution

Catheter related blood stream infections

Central venous catheters

Ehtanol

Hemodialysis

Hepatin

Linezolid

Urogenital system

Vancomylin