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

Objective

Evaluate the outcomes of various antibiotic lock solutions used for treatment of CRBSIs

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

74% success in catheter sterilization

52% of catheters were successfully salvaged

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