Anti-microbial locks increase the prevalence of Staphylococcus aureus and antibiotic-resistant Enterobacter: observational retrospective cohort study

作者：Dixon John J^*; Steele Maggi; Makanjuola A David

来源：Nephrology Dialysis Transplantation, 2012, 27(9): 3575-3581.

DOI：10.1093/ndt/gfs081

• antibiotic resistance
• haemodialysis catheter
• line locks

Anti-microbial lock solutions (AML), in conjunction with systemic antibiotics, may successfully treat tunnelled haemodialysis catheter-related bloodstream infections (CR-BSI). It is unknown whether AML promote anti-microbial resistance.
This is a retrospective cohort study of all CR-BSI (20032006) in our dialysis unit. Controls (n 265) were treated with systemic vancomycin and gentamicin. In addition to the systemic antibiotics, the study group (n 662) received AML containing vancomycin and gentamicin during inter-dialytic periods. Antibiotic sensitivity/resistance profiles of all organisms were analysed. Changes in the incidence of infection (chi-square test) and resistant organisms (Fishers exact test) were calculated.
The incidence of CR-BSI decreased from 8.50/1000 catheter days (controls) to 3.80 (study group; P 0.0001), and the incidence of relapses decreased (P 0.0027). The number needed to treat to prevent subsequent bacteraemia using an AML adjunct is 3 0.4. The proportion of Gram-positive cultures increased (P 0.0001), including Staphylococcus aureus (P 0.03), but the proportion of methicillin-resistant S. aureus (P 0.87) and vancomycin resistance (P 0.90) did not. Increased gentamicin resistance (P 0.0001) and ciprofloxacin resistance (P 0.04) were observed in Gram-negative cultures. Gentamicin resistance [relative risk (RR) 15.29; P 0.0001] and ciprofloxacin resistance (RR 6; P 0.007) increased in Enterobacter species, but not Pseudomonas or Escherichia coli species.
AML decrease CR-BSI incidence, although proportions of S. aureus and anti-microbial-resistant Enterobacter are increased.

• 出版日期2012-9