Successful prevention of tunneled central catheter infection by antibiotic lock therapy using cefazolin and gentamicin

Catheter-related bacteremia (CRB) is one of the various complications related to hemodialysis (HD). As a result of this high rate of infection, the antibiotic lock technique (ALT) has been recommended to prevent CRB. However, adverse effects of ALT such as increased emergence of strains resistant to antibiotics and increased mechanical dysfunction catheter were poorly evaluated. We prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 233 HD patients requiring 325 new tunneled catheters while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a tunneled catheter were assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1,000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1,000 U/ml) as a catheter lock solution during the interdialytic period. The present study aimed to assess the efficacy of ALT using cefazolin and gentamicin in reducing CRB in patients undergoing HD with tunneled central catheter and to identify its adverse effects. CRB developed in 32.4 % of patients in the no-antibiotic group and in 13.1 % of patients in the antibiotic group. CRB rates per 1,000 catheter-days were 0.57 in the antibiotic group versus 1.74 in the no-antibiotic group (p < 0.0001). Kaplan-Meier analysis also showed that mean CRB-free catheter survival was significantly higher in the antibiotic group than in the no-antibiotic group (log-rank statistic 17.62, p < 0.0001). There was statistically significant difference between the two groups in causative organisms of CRB, with predominance of negative culture in both groups, but this prevalence was higher in ALT group (57.9 vs 90.1 %, p < 0.0001), and the two groups also were different in prevalence of gram-positive bacteria as causing organisms (ALT group 21.05 vs = 0 % in control group, p < 0.0001). There was no statistically significant difference between the two groups in drug-resistant germs. There were statistically significant differences between the two groups in the catheter removal causes, with higher rate of infectious cause in control group (12.32 vs 2.22 %, p < 0.0001) and mechanical cause in ALT group (28.26 vs 37.78 %, p < 0.0001). The results suggest that ALT may be a beneficial means of reducing the CRB rate in HD patients with tunneled catheter, without association between ALT and emergence of strains resistant. However, mechanical complications were more prevalent in antibiotic group. Further studies are required to determine the optimal drug regimen, concentrations for ALT, and its adverse effects. © 2012 Springer Science+Business Media Dordrecht.

Atividade antibacteriana de óleos essenciais e avaliação de potencial sinergético

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O papel da equivalência de contato na Cr-classificação de germes de aplicações Cr-estáveis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Sobre a equivalência de contato topológica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Detecção de genes de beta-lactamases de amplo espectro em Pseudomonas aeruginosa resistentes aos carbapenêmicos isoladas em São José do Rio Preto - SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da utilização da técnica de lavagem das mãos pelo profissional de enfermagem em Unidade de Terapia Intensiva Neonatal

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Adesão dos profissionais de saúde às precauções de contato em unidade de terapia intensiva

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Percepções de profissionais que atuam em unidade de terapia intensiva sobre a ocorrência de infecções relacionadas à assistência

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Investigação epidemiológica em plantio de alface (Lactuca sativa) na cidade de Botucatu - SP visando detectar a presença de ovos de Taenia sp

Pós-graduação em Medicina Veterinária - FMVZ

Características sócio-demográficas e epidemiológicas da tuberculose: avaliação etnobotânica e da atividade antimicobacteriana das plantas utilizadas por uma comunidade indígena

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Similaridade genética pelo RAPD-PCR de cepas de Staphylococcus sp isolados de portadores humanos e de camas de uma unidade hospitalar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito da amoxicilina e do fluoreto no desenvolvimento do esmalte dentário de ratos

Pós-graduação em Ciências Odontológicas - FOAR

PROJECTIONS OF HYPERSURFACES IN R-4 WITH BOUNDARY TO PLANES

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

High genetic diversity among Pseudomonas aeruginosa and Acinetobacter spp. isolated in a public hospital in Brazil

In Brazil and other regions of the world, Pseudomonas aeruginosa and Acinetobacter spp. have emerged as important agents of nosocomial infection and are commonly involved in outbreaks. The main objective of the present study was to evaluate the genetic relationship among P. aeruginosa and Acinetobacter spp. isolated from patients in a public university hospital in northwestern Parana, Brazil, and report their antimicrobial resistance profile. A total of 75 P. aeruginosa and 94 Acinetobacter spp. isolates were phenotypically identified and tested for antibiotic susceptibility using automated methodology. Polymyxin B was tested by disk diffusion for P. aeruginosa. Metallo-beta-lactamase (MBL) was detected using a disk approximation test. Genotyping was performed using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Approximately 55% of the P. aeruginosa isolates and 92% of the Acinetobacter spp. isolates were multiresistant, but none were MBL-producers. ERIC-PCR revealed the presence of small clusters of carbapenem-resistant Acinetobacter spp., most likely OXA-type carbapenemase producers. Furthermore, high genetic diversity in P. aeruginosa and Acinetobacter spp. clinical isolates was observed, suggesting that cross-transmission is not very frequent in the studied hospital.

Caracterização de Bacteriófagos Infectando Isolados Clínicos de Pseudomonas aeruginosa Armazenados em uma Coleção de Cultura

To isolate, to concentrate and to purify bacteriophages from isolates of P. aeruginosa; To observe the capacity of bacteriophages to infect isolates of P. aeruginosa susceptible and multiresitant to antimicrobial; To caractherize bacteriphages by electronic microscopy techniques. 10 isolates of Pseudomonas aeruginosa from LEMC culture collection were submitted to the experiments of ideal temperature for the lyse region appearance in the MaConkey culture plate and 2 extraction methods for the concentration of the phages, clorophorm (Silankorva) and filtration plus centrifugation (Bergan). Three infected clinical isolates of multiresistant P. aeruginosa an one susceptible isolate ( PA01) were evaluated by 3 transmission electron microscopy techniques to caractherize phages morphologically (“on grid”, “on drop” and direct extraction from the lyse region of the culture plate). The ideal temperature to obtain lyses region was 37°C. The stock solutions, obtained through the methodologies of Sillankorva and Bergan, had satisfactory results in infecting the multiresistant isolate and the negative control. Among the 3 techniques of electronic microscopy tested the direct from the lyse plate was the best to obtain the micrography of the phages