Letter to the Editor – Brief papers about basic research or clinical experiences
Gentamicin-based prophylaxis in tunnelled indwelling central venous catheter limbs for haemodialysis do not result in bacterial resistances after a 9 year follow up period
La profilaxis con gentamicina de las ramas del catéter venoso central permanente tunelizado en hemodiálisis no causa resistencia bacteriana durante 9 años de evolución
Juan Fernandez-Gallego
, Luis Cermeño, Edison Rudas
Corresponding author
Servicio de Nefrología, Hospital Regional Universitario Carlos Haya, Málaga, Spain
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Of the 126 patients studied, 118 had a CVC in the internal jugular vein and 8 had it in the femoral vein. Any procedure involving the CVC employed a strict protocol of complete asepsis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Prophylaxis</span>: intraluminal post-HD locking with 5<span class="elsevierStyleHsp" style=""></span>mg Gentamicin (G)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>sodium heparin at 1% or 5% per limb. For 6 months, the trough serum level of G was measured (normal value: 0.2–2<span class="elsevierStyleHsp" style=""></span>μg/mL), subsequently changing to annual controls. If the level was >0.3–0.5<span class="elsevierStyleHsp" style=""></span>μg/mL, we reduced the lock to 3<span class="elsevierStyleHsp" style=""></span>mg/limb of G 0.5–2<span class="elsevierStyleHsp" style=""></span>mg/limb. The diagnosis of CVCB was based on the criteria of Beathard and Urbanes<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and the NKF guidelines on vascular access published in 2006<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>: clinical improvement in a patient with fever treated with antibiotics with or without removal of CVC, with positive blood cultures (BC+) normally from blood taken from the HD line and/or infrequently from the CVC limb, having excluded other foci of infection. All patients with CVCB had BC+, except one with BC−.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Treatment of CVCB. Gram positive organisms, vancomycin 1<span class="elsevierStyleHsp" style=""></span>g at the 1st HD and 500<span class="elsevierStyleHsp" style=""></span>mg at subsequent HDs for 3–4 weeks, or another antibiotics if appropriate; Gram negative, as indicated in the susceptibility testing, for 3–4 weeks. Key outcomes studied: ototoxicity: clinical hypoacusis and/or vertigo. Bacterial resistance to G: organisms normally sensitive to G: Gram+: coagulase negative <span class="elsevierStyleItalic">Staphylococcus aureus</span> sensitive to methicillin. Gram−: <span class="elsevierStyleItalic">Escherichia coli</span>, <span class="elsevierStyleItalic">Proteus</span>, <span class="elsevierStyleItalic">Serratia</span>, <span class="elsevierStyleItalic">Klebsiella</span>, <span class="elsevierStyleItalic">Enterobacter</span>, <span class="elsevierStyleItalic">Pseudomona aeruginosa</span>, etc. The minimum inhibitory concentration (MIC) of G for these bacteria is ≤4<span class="elsevierStyleHsp" style=""></span>μg/mL. Resistance was detected from the results of BCs and susceptibility testing, which expressed sensitivity (S) or resistance (R) to G and the MIC value for each organism. We present the other variables studied in the results section.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Results. The mean patient age was 68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29 years (21–85 years); 60 patients (48%) were women, 39 patients (31%) had diabetes. The mean time each patient remained in the study was 24 months. Thirty-eight patients were treated with prophylaxis for >30 months (30% of all study patients), mean time per patient was 50 months (31–108). On susceptibility testing, no resistance was detected in G-sensitive bacteria: the MCI was <4<span class="elsevierStyleHsp" style=""></span>μg/mL, except in two cases of CVCB due to methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>, and one case with BC(−).</p><p id="par0020" class="elsevierStylePara elsevierViewall">No patients had a diagnosis of ototoxicity. The mean trough level of G per patient was 0.17<span class="elsevierStyleHsp" style=""></span>μg/mL (0.05–0.31). The mean G lock per limb per patient was 3<span class="elsevierStyleHsp" style=""></span>mg (2–5), equivalent to 1.1–1.7<span class="elsevierStyleHsp" style=""></span>mg/mL/limb depending on the volume of the limb according to the type of catheter.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients diagnosed with CVCB: 11(8.7%). Patients admitted to hospital for CVCB: 4 (3.2%). Number of CVCB/CVC/1000 days: 0.17. CVC removed due to CVCB: 3 patients (2.4%). Mortality due to CVCB: 1 (0.8%). Number of CVCB: 15, <span class="elsevierStyleItalic">Staphylococcus aureus</span>: 8; <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>: 4; <span class="elsevierStyleItalic">Escherichia coli</span>: 1; <span class="elsevierStyleItalic">Streptococcus bovis</span>: 1, and BC(−): 1. CVC was removed due to recurrent CVCB in one patient, for failure to improve clinically of in one patient, and due to BC(−) in one patient with clinical remission. There were no other CVCB complications (endocarditis, spondylodiscitis), except in one patient who died due to sepsis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Discussion. The scientific literature demonstrates that in HD patients, prophylaxis with post-HD antibiotic locking of CVC limbs, including G, reduces morbidity and mortality from bacterial infection associated with CVCB (number of CVCB/CVC/1000 days, mortality and hospital admission due to CVCB) compared with patients with heparin lock alone.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Bacterial resistance to G has been reported.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> However, our experience since July 2003 in patients with CVC attending to the unit and treated with G locking in doses lower than those given in other units (a detail we consider fundamental due to iatrogenic effects), no bacterial resistance or ototoxicity was demonstrated after 9 years of follow-up.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Having seen our results, we must refer to the publication by Beathar and Urbanes<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> in which they rate the quality of care of a HD unit according to the number of CVCB/CVC/1000 days it obtains when complete asepsis is employed, an excellent result being a value ≤1. In our case, the practice of complete asepsis<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>prophylaxis meant that the number of CVCB/CVC/1000 days was 0.17. Although we are unable to compare another study, in 9 years, to obtain a mortality, removal of CVC, and hospital admission due to CVCB of 0.8%, 2.4%, and 3.2%, respectively, is an appreciable standard, obtained thanks to G prophylaxis<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>universal asepsis. This is further underlined by the absence of endocarditis or spondylodiscitis, except for one patient who died due to sepsis. Strict complete asepsis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> for all handling procedures of CVC is integral to prophylaxis in reducing morbidity and mortality from bacterial infection associated with CVCB.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Conclusions. This prospective observational study of 9 years’ duration in 126 HD patients with a CVC showed: (1) Prophylaxis with intraluminal G locking in CVC limbs does not cause antibiotic resistance in microorganisms sensitive to the antibiotic. (2) There were no diagnoses of clinical ototoxicity, and (3) Prophylaxis with administration of low-dose G (compared with higher doses in other studies)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> can result in the absence of resistance and ototoxicity.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernandez-Gallego J, Cermeño L, Rudas E. La profilaxis con gentamicina de las ramas del catéter venoso central permanente tunelizado en hemodiálisis no causa resistencia bacteriana durante 9 años de evolución. Nefrologia. 2015;35:418–419.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infection associated with tunneled hemodialysis catheter" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.A. Beathard" 1 => "A. Urbanes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-139X.2008.00497.x" "Revista" => array:6 [ "tituloSerie" => "Semin Dial" "fecha" => "2008" "volumen" => "21" "paginaInicial" => "528" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19000122" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines for vascular access: guidelines 7: prevention and treatment of catheter and port complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "NKF K/DOQI Guidelines" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2006.04.029" "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2006" "volumen" => "48" "numero" => "Suppl. 1" "paginaInicial" => "S176" "paginaFinal" => "S247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16813989" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La profilaxis con sellado de gentamicina de las ramas del catéter venoso central crónico tunelizado no causa resistencia bacteriana" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Fernández Gallego" 1 => "M. Martín" 2 => "E. Gutiérrez" 3 => "C. Cobelo" 4 => "P. Frías" 5 => "C. Jironda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2011.Feb.10257" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "308" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21407276" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between antimicrobial locks for hemodialysis central venous catheters and antibiotic resistance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Wolley" 1 => "S.L. Taylor" 2 => "F. Hossain" 3 => "S.A. Abbas" 4 => "M.R. Marshall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1542-4758.2012.00740.x" "Revista" => array:7 [ "tituloSerie" => "Hemodial Int" "fecha" => "2012" "volumen" => "16" "numero" => "Suppl. 1" "paginaInicial" => "S2" "paginaFinal" => "S9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23036031" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéteres para hemodiálisis?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Albalate" 1 => "R. Pérez García" 2 => "P. de Sequera" 3 => "R. Alcázar" 4 => "M. Puerta" 5 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 11 | 19 |
| 2024 October | 67 | 37 | 104 |
| 2024 September | 50 | 20 | 70 |
| 2024 August | 62 | 59 | 121 |
| 2024 July | 44 | 18 | 62 |
| 2024 June | 51 | 37 | 88 |
| 2024 May | 58 | 32 | 90 |
| 2024 April | 46 | 32 | 78 |
| 2024 March | 43 | 23 | 66 |
| 2024 February | 34 | 35 | 69 |
| 2024 January | 31 | 26 | 57 |
| 2023 December | 55 | 25 | 80 |
| 2023 November | 81 | 23 | 104 |
| 2023 October | 31 | 28 | 59 |
| 2023 September | 25 | 27 | 52 |
| 2023 August | 26 | 21 | 47 |
| 2023 July | 44 | 25 | 69 |
| 2023 June | 47 | 20 | 67 |
| 2023 May | 55 | 32 | 87 |
| 2023 April | 40 | 15 | 55 |
| 2023 March | 45 | 29 | 74 |
| 2023 February | 27 | 15 | 42 |
| 2023 January | 28 | 19 | 47 |
| 2022 December | 61 | 32 | 93 |
| 2022 November | 27 | 23 | 50 |
| 2022 October | 38 | 36 | 74 |
| 2022 September | 28 | 32 | 60 |
| 2022 August | 37 | 37 | 74 |
| 2022 July | 27 | 41 | 68 |
| 2022 June | 34 | 19 | 53 |
| 2022 May | 20 | 24 | 44 |
| 2022 April | 37 | 31 | 68 |
| 2022 March | 27 | 37 | 64 |
| 2022 February | 35 | 30 | 65 |
| 2022 January | 34 | 31 | 65 |
| 2021 December | 25 | 34 | 59 |
| 2021 November | 29 | 29 | 58 |
| 2021 October | 27 | 39 | 66 |
| 2021 September | 19 | 33 | 52 |
| 2021 August | 34 | 38 | 72 |
| 2021 July | 29 | 29 | 58 |
| 2021 June | 27 | 20 | 47 |
| 2021 May | 26 | 26 | 52 |
| 2021 April | 33 | 38 | 71 |
| 2021 March | 36 | 29 | 65 |
| 2021 February | 30 | 13 | 43 |
| 2021 January | 22 | 17 | 39 |
| 2020 December | 17 | 12 | 29 |
| 2020 November | 19 | 14 | 33 |
| 2020 October | 20 | 13 | 33 |
| 2020 September | 21 | 14 | 35 |
| 2020 August | 31 | 14 | 45 |
| 2020 July | 36 | 11 | 47 |
| 2020 June | 31 | 23 | 54 |
| 2020 May | 35 | 8 | 43 |
| 2020 April | 35 | 13 | 48 |
| 2020 March | 25 | 16 | 41 |
| 2020 February | 43 | 20 | 63 |
| 2020 January | 39 | 20 | 59 |
| 2019 December | 52 | 23 | 75 |
| 2019 November | 55 | 21 | 76 |
| 2019 October | 23 | 11 | 34 |
| 2019 September | 30 | 23 | 53 |
| 2019 August | 8 | 21 | 29 |
| 2019 July | 34 | 23 | 57 |
| 2019 June | 20 | 9 | 29 |
| 2019 May | 22 | 11 | 33 |
| 2019 April | 42 | 27 | 69 |
| 2019 March | 31 | 18 | 49 |
| 2019 February | 15 | 13 | 28 |
| 2019 January | 25 | 12 | 37 |
| 2018 December | 74 | 32 | 106 |
| 2018 November | 128 | 14 | 142 |
| 2018 October | 106 | 13 | 119 |
| 2018 September | 65 | 9 | 74 |
| 2018 August | 46 | 13 | 59 |
| 2018 July | 49 | 12 | 61 |
| 2018 June | 32 | 9 | 41 |
| 2018 May | 37 | 11 | 48 |
| 2018 April | 47 | 5 | 52 |
| 2018 March | 40 | 7 | 47 |
| 2018 February | 26 | 6 | 32 |
| 2018 January | 26 | 5 | 31 |
| 2017 December | 26 | 8 | 34 |
| 2017 November | 46 | 9 | 55 |
| 2017 October | 35 | 6 | 41 |
| 2017 September | 31 | 15 | 46 |
| 2017 August | 24 | 7 | 31 |
| 2017 July | 27 | 7 | 34 |
| 2017 June | 32 | 10 | 42 |
| 2017 May | 41 | 13 | 54 |
| 2017 April | 31 | 10 | 41 |
| 2017 March | 23 | 6 | 29 |
| 2017 February | 32 | 6 | 38 |
| 2017 January | 19 | 6 | 25 |
| 2016 December | 43 | 6 | 49 |
| 2016 November | 61 | 11 | 72 |
| 2016 October | 86 | 18 | 104 |
| 2016 September | 100 | 3 | 103 |
| 2016 August | 126 | 2 | 128 |
| 2016 July | 159 | 7 | 166 |
| 2016 June | 87 | 0 | 87 |
| 2016 May | 109 | 0 | 109 |
| 2016 April | 89 | 0 | 89 |
| 2016 March | 67 | 0 | 67 |
| 2016 February | 84 | 0 | 84 |
| 2016 January | 71 | 0 | 71 |
| 2015 December | 99 | 0 | 99 |
| 2015 November | 79 | 0 | 79 |
| 2015 October | 102 | 0 | 102 |
| 2015 September | 33 | 0 | 33 |
Show all
