678. The Impact of a Gentamicin-Citrate (GC) Catheter Lock Intervention on Outpatient Hemodialysis Catheter Associated Blood Stream Infections
Session: Poster Abstract Session: Preventing Catheter Associated Infections
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • IDSA Poster Sasha.pdf (375.9 kB)
  • Background: 

    Central line associated blood stream infection (CLABSI) is a major contributor to morbidity and mortality in patients dialyzed via a central venous catheter (CVC). Short-term studies using catheter-restricted, antimicrobial-anticoagulant lock solutions have demonstrated reductions in CLABSI. We investigated the impact of a GC (1 mg/ml Gentamicin + 4% Citrate) lock to reduce CLABSI rates over 2-years, and its effects on access function and patterns of bacterial resistance. 

    Methods: 

    Interdialytic locking of dialysis catheters with GC solution replaced standard anticoagulant-only solution for all Rochester General Health System patients receiving outpatient dialysis via CVCs from January 2009 to January 2011. CLABSI surveillance data was routinely collected using standard National Healthcare Safety Network definitions. CLABSI rates, alteplase use to maintain CVC patency, and incidence of gentamicin resistant bacteremias were compared for 24 months pre and post intervention using unpaired t-test. 

    Results: 

    During the 2-year intervention period, a quarterly average of 326 ± 22 dialysis patients with CVCs were treated with the GC lock protocol.  There was a 77% reduction in CLABSI rates compared to baseline (0.5 ± 0.2 infections/1000 catheter days vs. 2.1 ± 0.5 infections/1000 catheter days, p < 0.0005).  No change in access-associated bacteremia was observed for patients dialyzed via arteriovenous fistulae or grafts.  Alteplase use did not change significantly during the intervention (27 ± 5.7 treatments/ 1000 catheter days vs. 30.2 ± 5.5 treatments/1000 catheter days).  Gram positive bacteria caused 71/152 (47%) CLABSI during the pre-GC period and 40/41 (98%) post-GC. Although no significant increase in enterococcal CLABSI was noted during the intervention period (14.6% vs. 16%), a significant increase in gentamicin resistance of enterococcal CLABSI isolates was observed post intervention (83% vs. 12% resistance at baseline).

    Conclusion:

    Introduction of a GC intradialytic lock protocol has resulted in a 77% reduction in CLABSI rates for patients dialyzed via a CVC. Although no signifcant impact on catheter function was observed, emergence of gentamicin resistance in enterococcal CLABSI isolates does merit further study.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Christine Hamby, Pharm. D. 1, Kristen Buczynski, B.S. 2, Michelle Vignari, R.N. 2, Newell Miyako, R.N.2, Donna Farnsworth, R.N.3, Stephen Silver, M.D. 2, Edward Walsh, MD4 and Alexandra Yamshchikov, M.D. 5, (1)Rochester General Health System , Rochester, NY, (2)Rochester General Health System, Rochester, NY, (3)Unity Health System , Rochester, NY, (4)Rochester General Hospital, Rochester, NY, (5)Infectious Diseases , Rochester General Health System, Rochester, NY

    Disclosures:

    C. Hamby, None

    K. Buczynski, None

    M. Vignari, None

    N. Miyako, None

    D. Farnsworth, None

    S. Silver, None

    E. Walsh, None

    A. Yamshchikov, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.