[ impact of intraluminal vancomycin adminstration on prevention of hemodialysis catheter-related infections]

ABSTRACT

Percutaneously inserted double-lumen central venous hemodialysis catheters provide the nephrologist with an excellent temporary access for an immediate hemodialysis treatment and preserve the peripheral veins for the future creation of a permanent arteriovenous vascular access. Unfortunately catheter-related infections are usually common. In this study, the impact of intra luminal vancomycin administration on catheter-related infections in a group of hemodialyzed patients has been investigated. A total of 100 patients with renal failure requiring hemodialysis by way of double-lumen central venous catheters inserted into the internal jugular or subclavian vein in 6 months period, were randomly divided into two groups of receiving a single intravenous dose of 1000 mg of vancomycin during catheter insertion and no antibiotics. The rate of infection, in situ duration of the initial catheter, number of dialysis sessions per week, site of catheter, length of the catheter which was outside of the skin, catheter tip cultures and the presence of systemic infections related to the catheter, were recorded for every patient. The study period was terminated when the initial catheter was changed or removed for any reason. Catheter-related infection was observed in 6 patients 2 patients [4%] in the first group who received vancomycin and 4 patients [8%] in the second group who received no antibiotic [P= 0.05]. In regard to infection, 33.3% of the infections occurred in the first week after catheter insertion, 16.7% in the second week and 50% in the third week and there was no association between the duration of catheter fixation and infection [P= 0.7]. The type of the catheter [jugular or subclavian] and the length of the catheter which was outside of the skin had not any effect on the catheter infection [P= 0.5 and P= 0.6 respectively]. In all cases infection was due to staphylococcus. It can be concluded that in uremic patients, a single intravenous dose of vancomycin during the insertion of a double-lumen hemodialysis catheter into the internal jugular or subclavian vein has no effect on prevention of catheter-related infections