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Clinical Pharmacy Specialist, Infectious Diseases, Veterans Affairs Medical Center, West Palm Beach, FL
Pharmacy Practice Resident, VAMC, West Palm Beach
Reprints: Dr. Segarra-Newnham, Patient Support Service (119), VAMC, 7305 N. Military Trail, West Palm Beach, FL 33410-6400, fax 561/422-7220, marisel.segarra-newnham{at}med.va.gov
OBJECTIVE: To review the literature on the use of the antibiotic lock technique (ALT) as a treatment option for patients with highly needed catheters.
DATA SOURCES: MEDLINE and International Pharmaceutical Abstracts were searched (1980–August 2004). Search terms included antibiotic lock, catheter infection, and topical treatment.
STUDY SELECTION AND DATA EXTRACTION: Articles describing use of ALT in the treatment of catheter infections in humans and studies evaluating in vitro stability of antibiotics were included.
DATA SYNTHESIS: ALT has been used in patients with highly needed catheters, usually for parenteral nutrition, cancer chemotherapy, or dialysis. Catheters are considered highly needed when removal is not feasible or desirable due to lack of alternative injection sites for required therapy. Success rates in saving the infected catheter have been variable and may depend on the infecting organism. In addition, there are conflicting data in terms of compatibility of antibiotics with heparin solutions.
CONCLUSIONS: Consensus appears to be that the ALT can be tried for patients with highly needed catheters when infection with coagulase-negative staphylococci is documented and no systemic signs of sepsis, such as hypotension, are evident. Most of these patients are likely to need systemic therapy as well. Infection of the catheter associated with systemic gram-negative bacteremia or fungemia will most likely require removal of the catheter to prevent systemic complications. Additional research with the ALT is warranted given unanswered questions.
Key Words: catheter infection, topical antibiotic
Published Online, December 28, 2004. www.theannals.com, DOI 10.1345/aph.1E316
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