POS-626 IMPROVING CATHETER SURVIVAL IN CRBSI WITH ALCOHOL CATHETER LOCK SOLUTION

Abstract

Despite the advocation of fistula first strategy, over 80 % of the incident dialysis patients initiate dialysis with tunnelled dialysis catheters (TDC) and 30 % remain catheter dependent. catheter related blood stream infection (CRBSI) is a dreaded complication of tunnelled dialysis catheters with reported incidence rate of 1.1 to 5.5 per 1000 catheter days. Conventionally the management of CRBSI includes IV antibiotics along with antibiotic catheter lock solution. Despite this 30-50 % of catheters require removal, especially in the setting of staphylococcal, pseudomonas, and fungal infection. Literature does mention benefit of alcohol catheter locks solution but there is no published data on its use. This study aimed to compare efficacy and safety of 70% alcohol lock solution (ACL) vs antibiotic lock solution in CRBSI management. All patients on dialysis with TDC as vascular access were followed for CRBSI. CRBSI was diagnosed if in appropriate clinical setting patient had two cultures (from venous hub and dialysis circuit or peripheral vein) positive for same organism and with no other obvious focus of infection.During CRBSI patients received appropriate antibiotics and either antibiotic lock instilled after each dialysis session or 70% alcohol lock which was instilled for 3 consecutive days. If patient became asymptomatic after 3 days, catheter was kept and if patient remained symptomatic even after 3 days of therapy or had hemodynamic compromise, catheter was removed. 225 catheters were followed for a duration of 24010 days. 34 patients developed CRBSI. Twenty two patients (Group A) received antibiotics and antibiotic lock and 12 patients (Group B) received antibiotics and ACL instead of antibiotic lock. Demographic and clinical profile of the group A & B is given in table 1. Group A had 11 males and 11 females with mean age of 61.36 ± 8.54 years. Group B had 5 males and 7 females with mean age of 58 ± 16.94 years. Of the 22 patients of CRBSI in group A,15 required catheter removal and of the 12 patients in group B, none required catheter removal (P= 0.0095 ). After a mean follow up of 84.16 ± 44.62 days, none of the patients in group B developed relapse of infection or any catheter dysfunction. Based on our pilot study, we found 70% alcohol lock solution to be far superior than antibiotic lock solution with no effect on catheter performance and life in short term follow-up. We recommend alcohol lock solution during management of CRBSI episodes.