Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia

Am J Kidney Dis. 2006 Oct;48(4):596-605. doi: 10.1053/j.ajkd.2006.06.012.

Abstract

Background: Catheter-restricted antibiotic lock solutions were found to be effective in the prevention of catheter-related bacteremia (CRB), but insufficient data are available about the ideal agent and dose. We hypothesized that a low concentration of gentamicin would be as effective as the high doses studied in the past.

Methods: In this prospective, open-labeled, randomized, clinical trial of patients on long-term hemodialysis therapy, patients were randomly assigned to administration of an antibiotic lock solution of gentamicin/citrate (4 mg/mL), minocycline/EDTA, or the control solution of heparin. Patients were followed up until the study end point of CRB was reached or a censoring event occurred. Interim data analysis was performed after 6 months to assess data safety; efficacy was noted and the study was terminated early.

Results: Sixty-two patients were enrolled into the study, evenly distributed in 3 arms, with data from 1 patient excluded from analysis. Seven of 20 patients in the heparin group (4.0 events/1,000 catheter days), 1 of 21 patients in the minocycline group (0.4 events/1,000 catheter days), and none of 20 patients in the gentamicin group developed bacteremia. Results were statistically significant by using 2-tailed Fisher exact test; heparin versus gentamicin, P = 0.008, and heparin versus minocycline, P = 0.020.

Conclusion: Antibiotic lock solutions are superior to the standard heparin lock alone in the prevention of CRBs, and low-dose gentamicin solution has efficacy similar to that of greater concentrations used in previous studies.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy
  • Bacteremia / etiology
  • Bacteremia / prevention & control*
  • Catheterization / adverse effects*
  • Dose-Response Relationship, Drug
  • Female
  • Gentamicins / therapeutic use*
  • Humans
  • Infection Control / methods
  • Male
  • Middle Aged
  • Minocycline / therapeutic use*
  • Prospective Studies
  • Renal Dialysis / adverse effects
  • Renal Dialysis / instrumentation
  • Staphylococcus aureus

Substances

  • Anti-Bacterial Agents
  • Gentamicins
  • Minocycline