Slayt 1

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Antibiotic Lock Technique
Assoc. Prof. Serkan Oncu, MD ADU Medical
Faculty Dept. Of Infectious Diseases and Clinical
Microbiology
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gt 150 million intravascular catheters / year
Peripheral venous catheters
Central venous catheters
Others
gt 5 million / year
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5-15
Infection
10-15
Catheter-related infection
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Peripheral venous catheters Peripheral arterial
catheters Midline catheters Nontunneled central
venous catheters Pulmonary artery
catheters Peripherically inserted central
catheters Tunneled central venous
catheters Totally implantable catheters Umblical
catheters
High infection rate
Difficult to replace
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Contamination of catheter hub
Skin organisms
Contaminated infusate
Hematogenous seeding
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Catheter
Organism
Host
Surface properties
fibronectin fibrinogen fibrin
Slime
Bacterial attachment
Antibiotic penetration Phagocytosis Antibody
effect
Treatment failure
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The Antibiotic Lock Technique Consists of
filling the catheter lumen with an antibiotic
solution and allowing it to dwell for a period of
time, in order to sterilize the device
Messing, B. et al. JPEN J Parenter Enteral Nutr
198812-185-9
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Antibiotic Lock Technique
High antibiotic concentration Lack of
toxicity Low cost Ease of administration Home
therapy
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Efficacy of antibiotic-lock vs. conventional
treatment Usefullness of different types of
antibiotics Optimum concentration of
antibiotics Duration of treatment Necessity of
concurrent systemic antibiotic therapy
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Tunneled CVC or ID related infection
Complicated
Uncomplicated
Remove CVC/ID
CNS
S.aureus
Gram (-) bacilli
Fungus
SA (7 days) ALT (10-14 days)
SA (14 days) ALT (14 days)
SA (14 days) ALT (14 days)
Remove CVC/ID SA (14 days)
SA Systemic antibiotic ALT
Antibiotic Lock Theraphy
Mermel LA, et al. Clin Infect Dis 2001321249-72
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Polyurethane catheters
Slime () S.epidermidis
Slime (-) S.epidermidis
Vancomycin (5mg/dl)
Teicoplanin (5mg/dl)
Vancomycin (5mg/dl)
Teicoplanin (5mg/dl)
Sterile catheters
7 days
Oncu, S. et al. Tohoku J. Exp. Med., 2004, 203
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Polyurethane catheters
Slime () S.epidermidis
Slime (-) S.epidermidis
Vancomycin (5mg/dl) Vancomycin (3mg/dl) Vancomycin
(1mg/dl)
Vancomycin (5mg/dl) Vancomycin (3mg/dl) Vancomycin
(1mg/dl)
Teicoplanin (5mg/dl) Teicoplanin
(3mg/dl) Teicoplanin (1mg/dl)
Teicoplanin (5mg/dl) Teicoplanin
(3mg/dl) Teicoplanin (1mg/dl)
Sterile catheters
7 days
Oncu, S. and Sakarya, S. Curr Ther Res Clin Exp,
2005,66 364-374
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Silicone catheters
Slime
Slime
S.epidermidis
S.aureus
Slime -
Slime -
Seftriakson (83 mg/dL) Gentamisin (13
mg/dL) Vankomisin (83 mg/dL) Nafsillin (83
mg/dL)
Seftriakson (83 mg/dL) Gentamisin (13
mg/dL) Vankomisin (83 mg/dL) Nafsillin (83
mg/dL)
7 days
Sterile catheter
Deborah, AA et al. Nutrition, 1998, 14 427-432
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Polyurethane catheters
Slime
Slime
S.epidermidis
S.aureus
Slime -
Slime -
Vankomisin (5mg/mL) Teikoplanin
(5mg/mL) Siprofloksasin (5mg/mL)
Vankomisin (5mg/mL) Teikoplanin
(5mg/mL) Siprofloksasin (5mg/mL)
7 days
Sterile catheter
Lee, JY et al. JAC, 2006, 57 1110-1115
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Solid tumors
Non-neutropenic
Oncology patients
Tunneled CVC
Uncomplicated CVC infection
AL therapy
3 days
Vancomycin (5mg/ml)
Amikacin (5mg/ml)
Patients cured No recurrence
86
Sanchez-Munoz A, et al. Eur J Clin Microbiol
Infect Dis 200524291-293
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Solid tumors
Non-neutropenic
Children
Tunneled CVC
Uncomplicated CVC infection
AL therapy
8 days
Vancomycin (50mg/ml)
Patients cured No recurrence
80
Luigi DS et al. Ped Inf Dis 2004 10 963-965