Gentamicin-Resistant Bacteraemia Found in Haemodialysis Patients

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Gentamicin-Resistant Bacteraemia Found in Haemodialysis Patients Receiving Gentamicin Lock Catheter Prophylaxis: Presented at NKF

      By Deborah Brauser

      NASHVILLE, Tenn -- March 30, 2009 -- The long-term use of gentamicin/heparin lock (GHL) catheters can lead to gentamicin-resistant bacteraemia in haemodialysis patients, according to research presented here at the National Kidney Foundation (NKF) 2009 Spring Clinical Meetings.

      Investigative team member Daniel Landry, DO, Renal Division, Baystate Medical Center, Springfield, Massachusetts, reported the results here in a poster session on March 26.

      Although recent reviews have suggested that use of antibiotic locks for patients receiving catheter-dependent chronic dialysis can lead to a significant decrease in catheter-related blood stream infections (CRIs), there are currently no data regarding long-term consequences, Dr. Landry explained during his presentation.

      In their study, Dr. Landry and colleagues assessed 4 years worth of data on the consequences of antibiotic locks for patients receiving catheter-dependent chronic dialysis. "It's really one of the first studies to really go out past 1 year in terms of documenting this issue of antibiotic-related resistance," he said.

      In the retrospective analysis, the researchers evaluated charts from 1,488 patients treated with chronic maintenance haemodialysis who received a GHL protocol through a tunnelled catheter in 1 inpatient unit and 8 outpatient units from October 2002 to September 2006.

      Results of the analysis showed that while use of a GHL effectively reduced the CRI rate, gentamicin-resistant CRIs emerged and were associated with significant morbidity and mortality.

      Within the study's first year, the CRI rate decreased from 17 to 3.7 events per 1,000 catheter-days (relative risk reduction = 0.78). However, beginning 8 months after the GHL protocol's initiation, febrile incidents occurred in 19 patients with 26 episodes of coagulase-negative Staphylococcus aureus resistant to gentamicin.

      Over the next 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (8 cases of Enterococcus faecalis, 1 case of methicillin-sensitive S aureus, and 2 cases of Streptococcus salivarius).

      Of the 29 patients with gentamicin-resistant CRI, there were 6 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Treatment procedures for these patients included catheter removal and 2 to 8 weeks of intravenous antibiotics.

      Due to these events, it was concluded that these infections are a serious complication of the long-term use of GHL and its application was discontinued in 2006.

      "Our study looked at a 4-year cohort of dialysis patients using a gentamicin catheter lock to prevent infections," explained Dr. Landry. "And what we're finding now is that the severity and degree of resistance, which hasn't been documented before, really is present. Because of that, I think going forward, we need to weigh the risk-benefit [ratio] of using the antibiotic catheter lock in our dialysis patients."

      He continued, "Once we saw the rate of infections that were arising and the amount of comorbid conditions associated with them, we had to make some major changes, obviously. I think the next step clearly is that we need to look more into the use of nonantibiotic catheter locks for the prevention of dialysis catheter-related infections."

      [Presentation title: Emergence of Gentamicin-Resistant Bacteremia in Hemodialysis Patients Receiving Gentamicin Lock Catheter Prophylaxis. Abstract 167]

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