A Randomized Controlled Study On Prevention Of Catheter-Related Bacteremia With Gentamicin-heparin Lock Solution

Background Cuff-tunneled catheters are being increasingly essential for the provision of hemodialysis. Approximately 24% of the hemodialysis patients in the United States rely on tunneled catheters as the vascular access. Catheter-related bacterernia (CRB) is a major cause of untimely catheter removal and for morbidity in dialysis patients. Data show that the average CRB incidence is 0.7-5.5 episodes per 1000 catheter days. How to reduce the incidence of CRB is important for clinical practice. Though antibiotic lock treatment has recently emerged as a promising option by reducing bacterial colonization and biofilm, their use is restricted by undesirable side effects and the evidence in the form of randomized controlled trials is lacking.Aim To determine whether a strategy based on locking with gentamicin and heparin could reduce the incidence of CRB.Methods Find proper concentration of gentamicin-heparin lock solution and' investigate its antibiotic activity in vivo. 43 studied patients in our center were randomized to catheter-restricted filling with either sandard heparin (45mg/ml) alone, or gentamicin and heparin (4mg/ml-45mg/ml). The routine investigations include the incidence of CRI,the concentration of gentamicin in peripheral blood, the residual kidney function (KUR), the side effect of gentamicin, and the change of blood level of CRP, IL-6.Results Median catheter was 71.69±28.08(range, 31-139d) in the gentamicin-heparin (GH) group and 75.53±27.98(range, 40-135d) in the heparin(H) group. Overall, 1649catheter days were accrued in the GH group and 1450 in H group. None of the patients developed CRI in both two groups. Average Kt/V are 1.5±0.09 and 1.52±0.05 in GH and H groups respectively. In GH group, the top and bottom gentamicin concentration in two weeks are 0.23±0.12ug/ml and 0.53±0.29ug/ml, 0.26±0.15ug/ml and 0.67±0.32ug/ml on 12 weeks. No statistical difference was found between top and bottom gentamicin concentration and there was also no difference on the level of CRP, IL-6 , KRU between two groups.Conclusion The incidence of CRB in our center is very low. We cannot find theadvantages of gentamcin-lock on prevention of CRB and improve the situation of chronic inflammation of hemodialysis patients in a short time, and also with no obvious side effects of gentamcin lock. The prevention of CRB should focus on the quantity management of the dialysis center, the use of antibiotic is not promoted. Central venous cuff-tunneled catheter has the advantage of safety and effectively. It is a promising choise for the uremic patients with peripheral vascular failure or waiting for renal transplantation.