ABSTRACT
Introducción: La profilaxis con sellado de gentamicina de las ramas del catéter venoso central tunelizado en hemodiálisis crónica disminuye la morbimortalidad infecciosa bacteriana asociada a la bacteriemia del catéter. Objetivo: Valorar en un estudio prospectivo observacional de siete años de duración de 101 pacientes en hemodiálisis crónica con catéter tratados con profilaxis la aparición de resistencia bacteriana al antibiótico en gérmenes habitualmente sensibles a su acción. Material y métodos: Protocolo de asepsia universal en el manejo del catéter. Sellado intraluminal de las ramas posdiálisis con gentamicina 5 mg/rama + heparina sódica al 1%, monitorizando su nivel valle en sangre y (..) (AU)
Introduction: Prophylaxis with gentamicin locking of chronic tunnelled central venous catheter branches in chronic haemodialysis patients reduces bacterial infections and morbidity and mortality associated with catheter bacteraemia. Aim: We undertook a 7-year, prospective, observational study involving 101 patients on chronic haemodialysis with catheters treated with prophylaxis to evaluate the appearance of bacterial resistance to the antibiotic in pathogens usually sensitive to its action. Material and Methods: A protocol of universal asepsis in catheter management. Postdialysis intraluminal locking of the branches with gentamicin at 5mg/branch + 1% heparin sodium, monitoring trough levels in blood and modifying the dose according to the established protocol. The diagnosis of bacteraemia was based on usual criteria. The main study variables were: Diagnosis by the bacteriology department of bacterial resistance in pathogens sensitive to gentamicin. Diagnosis of clinical ototoxicity. Secondary variables were: Patients hospitalised/bacteraemia; number of bacteraemia/catheter/1000 days; infectious mortality; and catheter withdrawal/bacteraemia. Pathogens found in blood culture. Results: Main variables: We found no resistance of pathogens usually sensitive to the antibiotic. Nor was there clinical ototoxicity. The mean number of months each patient remained in the study was 23 (1-84). Secondary variables: Three patients (3%) were hospitalized due to bacteremia; number of bacteremias, 8; number of (..) (AU)
Subject(s)
Humans , Antibiotic Prophylaxis , Catheter-Related Infections/prevention & control , Gentamicins/therapeutic use , Renal Insufficiency, Chronic/epidemiology , Renal Dialysis/methods , Bacteremia/prevention & control , Drug Resistance, Bacterial , Prospective StudiesABSTRACT
INTRODUCTION: Prophylaxis with gentamicin locking of chronic tunnelled central venous catheter branches in chronic haemodialysis patients reduces bacterial infections and morbidity and mortality associated with catheter bacteraemia. AIM: We undertook a 7-year, prospective, observational study involving 101 patients on chronic haemodialysis with catheters treated with prophylaxis to evaluate the appearance of bacterial resistance to the antibiotic in pathogens usually sensitive to its action. MATERIAL AND METHODS: A protocol of universal asepsis in catheter management. Postdialysis intraluminal locking of the branches with gentamicin at 5mg/branch + 1% heparin sodium, monitoring trough levels in the blood and modifying the dose according to the established protocol. The diagnosis of bacteraemia was based on usual criteria. The main study variables were: Diagnosis by the bacteriology department of bacterial resistance in pathogens sensitive to gentamicin. Diagnosis of clinical ototoxicity. Secondary variables were: Patients hospitalised/bacteraemia; number of bacteraemia/catheter/1000 days; infectious mortality; and catheter withdrawal/bacteraemia. Pathogens found in blood culture. MAIN VARIABLES: We found no resistance of pathogens usually sensitive to the antibiotic or clinical ototoxicity. The mean number of months each patient remained in the study was 23 (1-84). Secondary variables: Three patients (3%) were hospitalised due to bacteraemia; number of bacteraemias: 8; number of bacteraemia/catheter/1000 days: 0.11; infectious mortality per bacteraemia: 1 patient (1%); catheter withdrawal due to bacteraemia: 2 (2%). No patients were diagnosed with endocarditis or spondylodiscitis. The mean trough level of gentamicin in each patient during the study was 0.17µg/ml (0.05-0.31); the mean intraluminal gentamicin locking dose per branch was 3mg (2-5), equivalent to 1.1-1.7mg/ml/branch. CONCLUSIONS: This 7-year, prospective observational study of 101 patients on chronic haemodialysis with tunnelled central venous catheters showed: 1) Prophylaxis with intraluminal gentamicin locking of the catheter branches does not cause bacterial resistance in pathogens sensitive to its action. 2) No clinical ototoxicity was seen. 3) The lack of resistance and ototoxicity may be influenced by the gentamicin prophylaxis dose used, which was much lower than in other studies.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous , Gentamicins/therapeutic use , Renal Dialysis , Adult , Aged , Aged, 80 and over , Catheterization, Central Venous/instrumentation , Drug Resistance, Bacterial , Female , Humans , Male , Middle Aged , Prospective Studies , Young AdultSubject(s)
Anemia/drug therapy , Ferric Compounds/therapeutic use , Ferritins/blood , Anemia/blood , Anemia/etiology , Blood Proteins/drug effects , Case-Control Studies , Clinical Protocols , Drug Monitoring , Erythropoiesis , Erythropoietin/therapeutic use , Ferric Compounds/administration & dosage , Ferric Compounds/adverse effects , Ferric Oxide, Saccharated , Glucaric Acid , Humans , Infusions, Intravenous , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Oxidation-Reduction , Prospective Studies , Renal Dialysis/adverse effectsABSTRACT
No disponible
Subject(s)
Humans , Ferritins/blood , Iron/administration & dosage , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Clinical ProtocolsSubject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Gentamicins/therapeutic use , Adult , Aged , Aged, 80 and over , Bacterial Infections/complications , Bacterial Infections/mortality , Catheterization, Central Venous/instrumentation , Equipment Design , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Gentamicins/pharmacokinetics , Antibiotic Prophylaxis , Catheters, Indwelling/microbiology , Infections/microbiology , Infection Control/methodsSubject(s)
Anemia, Hypochromic/drug therapy , Erythropoietin/administration & dosage , Hemoglobins/analysis , Iron/administration & dosage , Renal Dialysis , Anemia, Hypochromic/blood , Anemia, Hypochromic/etiology , Case-Control Studies , Dose-Response Relationship, Drug , Drug Therapy, Combination , Erythropoietin/therapeutic use , Ferritins/blood , Humans , Infusions, Intravenous , Iron/therapeutic use , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapy , Prospective Studies , Renal Dialysis/adverse effectsABSTRACT
No disponible
Subject(s)
Humans , Anemia, Hypochromic/drug therapy , Erythropoietin/administration & dosage , Hemoglobins/analysis , Renal Dialysis/adverse effects , Anemia, Hypochromic/blood , Anemia, Hypochromic/etiology , Case-Control Studies , Drug Therapy, Combination , Erythropoietin/therapeutic use , Infusions, Intravenous , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/therapy , Prospective Studies , Ferritins/bloodABSTRACT
No disponible
Subject(s)
Humans , Catheterization, Central Venous/adverse effects , Renal Dialysis/mortality , Bacteremia/etiology , Bacteremia/mortality , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Catheterization, Central Venous/instrumentation , Equipment Design , Prospective StudiesSubject(s)
Iron/adverse effects , Renal Dialysis , Writing , Anemia/drug therapy , Anemia/etiology , Ferritins/analysis , Hospitalization/statistics & numerical data , Humans , Infusions, Intravenous , Iron/administration & dosage , Iron/therapeutic use , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/therapy , Oxidation-Reduction , Renal Dialysis/adverse effects , Uremia/metabolismABSTRACT
No disponible
Subject(s)
Humans , Iron/adverse effects , Renal Dialysis/adverse effects , Writing , Anemia , Hospitalization/statistics & numerical data , Infusions, Intravenous , Iron/administration & dosage , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/therapy , Oxidation-Reduction , Uremia , Ferritins/analysisSubject(s)
Catheterization, Central Venous/adverse effects , Renal Dialysis/mortality , Bacteremia/etiology , Bacteremia/mortality , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Catheterization, Central Venous/instrumentation , Equipment Design , Humans , Prospective StudiesSubject(s)
Hospitalization/statistics & numerical data , Iron/adverse effects , Kidney Failure, Chronic/mortality , Renal Dialysis , Aged , Anemia/drug therapy , Anemia/etiology , Female , Humans , Infusions, Intravenous , Iron/administration & dosage , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Prospective StudiesSubject(s)
Anemia/etiology , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Renal Dialysis/methods , Aged , Anemia/diagnosis , Anemia/drug therapy , Epoetin Alfa , Erythropoietin/therapeutic use , Female , Hematinics/therapeutic use , Hematologic Tests , Humans , Male , Prospective Studies , Recombinant Proteins , Renal Dialysis/adverse effects , Risk FactorsSubject(s)
Anemia/blood , Cardiovascular Diseases/mortality , Hematocrit , Hospitalization/statistics & numerical data , Kidney Failure, Chronic/complications , Renal Dialysis/statistics & numerical data , Aged , Anemia/drug therapy , Anemia/etiology , Arteriovenous Shunt, Surgical , Cardiovascular Diseases/epidemiology , Catheterization, Central Venous , Comorbidity , Erythropoietin/administration & dosage , Erythropoietin/adverse effects , Erythropoietin/blood , Erythropoietin/therapeutic use , Female , Hemoglobins/analysis , Humans , Infections/epidemiology , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/therapy , Male , Middle Aged , Practice Guidelines as TopicABSTRACT
No disponible
Subject(s)
Female , Aged , Male , Middle Aged , Humans , Anemia/blood , Anemia/drug therapy , Cardiovascular Diseases/epidemiology , Erythropoietin/administration & dosage , Erythropoietin/adverse effects , Erythropoietin/blood , Hematocrit , Hospitalization/statistics & numerical data , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/therapy , Arteriovenous Shunt, Surgical/methods , Cardiovascular Diseases/mortality , Catheterization, Central Venous/methods , Comorbidity , Erythropoietin/therapeutic use , Hemoglobins/analysis , Infections/epidemiology , Renal Insufficiency, Chronic/mortality , Practice Guidelines as Topic , Renal Dialysis/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Middle Aged , Humans , Renal Dialysis , Prospective Studies , Injections, Intravenous , Infections , IronABSTRACT
Several factors influence the efficacy of the action of human recombinant erythropoietin during treatment of anaemia in haemodialysis patients. We carried out a six-month prospective study of 23 stable patients who had been on haemodialysis for at least one year to attempt to evaluate those factors modifying the dose of the hormone to attain a similar haematocrit, such as use or not of angiotensin converting enzyme inhibitors, hepatitis C virus positive or negative, age older or younger than 60 years, acquired cystic kidney disease or not, and sex. The patients were treated with subcutaneaous erythropoietin for over a year to attain a haematocrit of 35%, intravenous iron to reach plasma ferritin levels > 250 ng/ml and a transferrin saturation index > 20%, folic acid and group B vitamins. Parameters studied included age, time and duration of haemodialysis, Kt/V, albumin, haematocrit, erythropoietin in U/kg/week, intact PTH, hepatitis C virus, PCR of the hepatitis C virus, transaminases, ferritin, transferrin saturation index, folic acid, vitamin B12, and aluminium. No statistically significant differences were seen between the patients with and without hepatitis or in age or acquired cystic kidney disease and sex in the hormone dose given to achieve similar levels of haematocrit. Higher doses of erythropoietin were necessary in those patients treated with antihypertensive agents (71 +/- 25 vs 44 +/- 25 U/kg/week; p < 0.05). There were no differences between groups in factors known to cause resistance to the action of the hormone. The most important conclusions from this study concern the cost-benefit relation of treating hypertensive patients on haemodialysis with angiotensin converting enzyme inhibitors and erythropoietin.