Poor Outcome of Antibiotic-Lock Technique for Therapy of Hemodialysis Catheter Related Staphylococcus Aureus Bacteremia

Catheter-related Staphylococcus aureus bacteremia is a common cause of hospitalization in hemodialysis patients with a tunneled cuffed catheter as vascular access. Although tunneled cuffed catheter-related bacteremia may occur, the catheter and the venous site may represent the last readily available form of access, and thus an initial attempt at salvaging an infected catheter is justified. The antibiotic lock technique has been advocated if the infected device is to remain in place for a certain period of time. Only a limited number of case studies, however, have described the effects of antibiotic lock in treating the catheter-related Staphylococcus aureus bacteremia. We retrospectively analyzed 8 patients with 12 episodes of tunneled cuffed-related Staphylococcus aureus bacteremia who received systemic Vancomycin and Vancomycin lock therapy. In only four episodes was the infection successfully treated (by definition). The other attempts failed and in five episodes severe complications arose, resulting in the death of four of the patients. The patients with leukocytosis, hypoalbuminemia or anemia tended to have a poor outcome; but only the presence of leukocytosis showed statistical significance (P=0.028). Leukocytosis might predict a poor outcome in patients receiving antibiotic lock protocol. We, therefore suggest the early removal of a catheter if the pathogen is Staphylococcus aureus. Due to a high recurrent infection rate, AV shunt operation should be done as soon as possible, even in patients with initial treatment success by antibiotic lock.