Long-Term Prophylaxis Cuts CVC Infection Risk

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Long-term use of a topical antibiotic application at central venous catheter (CVC) exit sites in hemodialysis (HD) patients may result in a sustained decrease in all CVC-related infections, according to a Canadian study.

Charmaine E. Lok, MD, MSc, of the University Health Network-Toronto General Hospital and the University of Toronto, and colleagues studied 228 long-term HD patients using a tunneled cuffed CVC. The researchers prospectively monitored the impact of routine topical polyantibiotic ointment application at CVC exit sites once a week as infection prophylaxis. This infection-control practice was fully implemented at the hospital in 2004. The researchers considered 2003 to be a transition period before full implementation of this protocol as standard care.

The hospital implemented the protocol based on the results of a randomized, double-blind trial (Hemodialysis Infection Prevention with Polysporin Ointment [HIPPO]), which showed that those who received the ointment had improved bacteremia and survival rates compared with those who did not.

From the transition period to the end of the study (December 31, 2009), 492 CVC-related infections developed in 228 patients, Dr. Lok's group reported in the American Journal of Kidney Disease (2011;57:432-441). During this time, the overall CVC related infection rate was 0.99 per 1,000 catheter-days and the overall bacteremia rate ranged0.26-0.70 per 1,000 catheter-days. These rates are lower than many reported in the literature, according to the investigators, who noted that a median rate of 3.0-4.0 per 1,000 catheter-days frequently is reported.

With respect to the causative organisms, gram-positive bacteria accounted for 61.2% of exit-site infections and 72.1% of bacteremias, the authors noted.

“Use of a topical polyantibiotic ointment at the CVC exit site with careful surveillance and guidance of infection management by a multidisciplinary team is an effective prophylactic strategy against HD catheter-related infections,” the researchers concluded.

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