Joel Topf, M.D. interviews Sumi J. Sun, one of the lead researchers on
new applied clinical research presented at Kidney Week 2017
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TITLE: Sustained Low Central Venous Catheter-Related Bloodstream Infection
Rates in HD Patients with an Antibiotic Look over a 3-year Period
AUTHORS: Sumi J. Sun, M.D., Norma Gomez, M.D. Fang Yang, M.D., Graham E.
Abra, M.D., Brigitte Schiller, M.D.
INSTITUTIONS: Satellite Healthcare clinics in San Jose, CA, United States;
Stanford University, Palo Alto, CA, United States
BACKGROUND: CVCs are associated with catheter-related bloodstream infection
(BSI) resulting in increased morbidity and mortality. Following our report
of significantly reduced infection when 320 mg/mL gentamicin in 4 percent
citrate is used as the CVC locking solution (Moran AJKD 2012), this has
remained the standard care in patients dialyzing with a CVC, unless the
physician ordered otherwise. The infection rates were monitored through
an internal QC program developed for National Healthcare Safety Network
METHODS: This study evaluated NHSN data with self-reported infection rates
from January 2014 to December 2016 in a nonprofit dialysis provider with
a total of 57 free-standing dialysis facilities serving more than 5000
HD patients. BSI was reported according to NHSN criteria. Data were audited
through comparison to an internal infection control report and discrepancies
reconciled prior to the final NHSN submission. Blood cultures were mandated
before any antibiotic administration for suspected BSI, and 85 percent
were sent to one internal lab (Ascend).
RESULTS: The rate of catheter-related bloodstream infection over the three
years was 1.00 episodes/100 patient months, 54 percent lower than the
national average of 2.16 for CVC-related BSI (2014 NHSN BSI Pooled Mean
Rate/100 patient months). Monthly BSI rates showed minor fluctuations,
however none exceeded the national average in any given month.
CONCLUSION: Gentamicin 320mg/mL in 4 percent sodium citrate as a routine
catheter lock demonstrated sustained low CVC related BSI rates in HD patients,
with approximately half the infection rate compared with the national
average. Gentamicin-citrate lock should be considered the standard of
care in patients with CVC access.