Prevention of hemodialysis catheter-related bloodstream infection using an antimicrobial lock

Abstract

Among currently available vascular access options for hemodialysis, central venous catheters show the poorest reliability, with frequent complications of thrombosis and stenosis impairing patency. The most serious problem, however, is catheter-related bloodstream infection (CRBI), which is typically a cause for removal of the catheter and protracted systemic antibiotic therapy. In our experience, a totally implanted device (Dialock, Biolink Corp.) seems to confer a better global protection against catheter-related infections than standard tunneled catheters, accounting for 0.97 vs. 4.75 infection episodes/1,000 catheter-days, respectively (p < 0.001). Bloodstream infection rates, however, are not statistically different in the two groups (0.85 vs. 0.81 per 1,000 catheter-days; p = n.s.), indicating that the improvement is mainly related to local cutaneous infections. On the other hand, in the Sodemann experience, a new taurolidine-based lock solution (Neutrolin, Biolink Corp.) greatly reduced CRBI rates with both subcutaneous ports and tunneled catheters to 0.29 and 0.20 episodes/1,000 catheter-days, respectively. These promising results await further confirmation from ongoing clinical trials.