Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Oct;5(10):1799-804.
doi: 10.2215/CJN.01270210. Epub 2010 Jul 1.

Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis

Daniel L Landry  1 , Gregory L Braden, Stephen L Gobeille, Sarah D Haessler, Chirag K Vaidya, Stephen J Sweet
Affiliations

Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis

Daniel L Landry et al. Clin J Am Soc Nephrol. 2010 Oct.

Abstract

Background and objectives: Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related blood stream infections (CRIs), but there are no data regarding the long-term consequences of this practice.

Design, setting, participants, & measurements: Over a 4-year period, from October 1, 2002, to September 30, 2006, we initiated a gentamicin and heparin lock (GHL) protocol in 1410 chronic hemodialysis patients receiving dialysis through a tunneled catheter in eight outpatient units.

Results: Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006.

Conclusions: Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Total bacteremias from October 2002 to September 2006. *Patients exposed to TCCs and GHL within the preceding 6 months.
Figure 2.
Figure 2.
CRI rates and cases of gentamicin resistance.
See this image and copyright information in PMC

References

    1. Centers for Medicare and Medicaid Services: 2004 Annual report: End-stage renal disease clinical performance measures project. Am J Kidney Dis 46: 1–100, 2005
    1. Vascular Access Working Group: Clinical practice guidelines for vascular access. Am J Kidney Dis 48[Suppl 1]: S248–S273, 2006 - PubMed
    1. Allon M: Dialysis catheter-related bacteremia: Treatment and prophylaxis. Am J Kidney Dis 44: 779–791, 2004 - PubMed
    1. Allon M, Depner TA, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne DW, Gassman JJ, Kaufman AM, Kaysen GA, Lewis JA, Schwab SJ: Impact of dialysis dose and membrane on infection-related hospitalization and death: Results of the HEMO study. J Am Soc Nephrol 14: 1863–1870, 2003 - PubMed
    1. Dogra GK, Herson H, Hutchison B, Irish AB, Heath CH, Golledge C, Luxton G, Moody H: Prevention of tunneled haemodialysis catheter-related infections using catheter-restricted gentamicin and citrate: A randomized controlled study. J Am Soc Nephrol 12: 2133–2139, 2002 - PubMed

MeSH terms