Hemodialysis Antibiotic Lock Cuts Infection Risk

Gentamicin and citrate decreased the likelihood of catheter-related infections and mortality.
Gentamicin and citrate decreased the likelihood of catheter-related infections and mortality.

The use of a prophylactic antibiotic lock solution in hemodialysis (HD) patients is associated with significant reductions in catheter-related infections and mortality, according to a study published online ahead of print in the Clinical Journal of the American Society of Nephrology.

Carol Moore, PharmD, and colleagues from Henry Ford Hospital in Detroit found that a locking solution of gentamicin and citrate lowered catheter-related bloodstream infections by 73% and mortality by 68 % compared with heparin. The study evaluated a cross-over from heparin (1,000 units/mL) to a low-dose gentamicin/citrate solution (0.32 mg/mL gentamicin in 4% trisodium citrate) in 555 chronic HD patients using permanent tunneled cuffed catheters in three outpatient centers in the Detroit metropolitan area. Half of the patients were men and 71% were black; their median age was 62 years.

The authors noted in their paper that there has been no improvement in catheter-related infections and mortality in the past 2 decades. “Advances in treatment have been elusive over the years. Perhaps our study can be a starting point to change the paradigm as a standard of care,”  senior author Jerry Yee, MD, said in a Henry Ford press release.

The development of antimicrobial resistance from antibiotic catheter-lock solutions is a major concern for the Centers for Disease Control and Prevention in Atlanta, precluding recommendations for the routine use of such solutions, according to the authors.

However, they found that gentamicin resistance decreased 2-fold from the control to the antibiotic-lock period. The investigators speculated that this may be related to the use of a low dose of gentamicin or of citrate as opposed to heparin, which may increase biofilm production, which in turn, can increase antimicrobial resistance.

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