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Transcript of Katherine Gerrald, PharmD Candidate 1 ; Anne Hishon, PharmD Candidate 1 ; P. Brandon Bookstaver,...
Katherine Gerrald, PharmD Candidate1; Anne Hishon, PharmD Candidate1;
P. Brandon Bookstaver, PharmD, BCPS2
1University of South Carolina, College of Pharmacy, Columbia, SC;2South Carolina College of Pharmacy, USC Campus, Columbia, SC
Treatment Outcomes of Novel Antibiotic Lock
Solutions: A Case Series Analysis
Catheter Related Bloodstream Infection (CRBSI)
An estimated 35,000 CRBSIs occur yearly
Mortality rates range from 12-35%1
Common CRBSI pathogens2 Coagulase-negative Staphylococcus sp. (CoNS) Staphylococcus aureus Aerobic gram negative bacilli Candida albicans
Biofilms provide a challenge to eradicating CRBSIs
¹CDC. Am J Infect Control 1998;26:522-33. 2Mermel LA, et al. Clin Infect Dis 2001:32 (1 May):1249-1272.
Antibiotic Lock Therapy (ALT)
High concentrations of antibiotic +/- anticoagulant 100-1000x > MIC
Selection based on causative organism
ALT Literature
National guidelines state: “Antibiotic lock therapy is recommended for
treatment when the catheter is retained.” [B-III]1
ALT has been shown to shorten hospital stay2
1Mermel LA, et al. Clin Infect Dis 2001;32:1249-72 2Bestul MB, et al. Pharmacother 2005;25:211-27
Methods
Retrospective Case Analysis
Inclusion: ALT >24 hours Treatment of CRBSI
Primary Endpoint: Catheter sterilization at 30 days
Secondary Endpoint: Catheter survival
Demographic Data
Number of cases 27
Age, mean 12.75
yr
range 1mo-
82yr
Males, n (%) 9(60)
Females, n (%) 6(40)
Med-Onc service, n (%) 5(33)
Pediatric service, n (%)
7(47)
Adult IM service, n (%)
3(20)
Indication for Central Line
Results
Antibiotic nCatheter Sterilizati
on
Catheter Salvage
Daptomycin 6 100% 83.3%
Gentamicin 7 100% 42.8%
Vancomycin 8 37.5% 50%
Ethanol 1 100% 0%
Vancomycin + Ethanol
2 50% 50%
Vancomycin + Gentamicin
3 66% 33.3%
Results
Organism n Catheter Sterilizati
on
Catheter Salvage
MSSA 1 0% 0%
MRSA 5 80% 60%
CoNS 8 87.5% 87.5%
Enterococcus sp.
2 0% 0%
Streptococcus sp.
1 100% 0%
GNRs 7 85% 28.6%
Polymicrobial 3 66.7% 66.7%
Conclusion
Successful as addition to systemic antimicrobial therapy in achieving catheter sterilization and salvage
Lock solutions containing gentamicin or daptomycin were most successful in catheter sterilization
Enterococcus species difficult to eradicate without catheter removal
Duration of therapy is unclear
Prospective trials needed
Katherine Gerrald, PharmD Candidate1; Anne Hishon, PharmD Candidate1;
P. Brandon Bookstaver, PharmD, BCPS2
1University of South Carolina, College of Pharmacy, Columbia, SC;2South Carolina College of Pharmacy, USC Campus, Columbia, SC
Treatment Outcomes of Novel Antibiotic Lock
Solutions: A Case Series Analysis