Saxena AK et al. (2006) Tunneled catheters' outcome optimization among diabetics on dialysis through antibiotic-lock placement. Kidney Int 70: 1629–1635

Tunneled cuffed catheters (TCCs) are frequently the only vascular access option for hemodialysis patients with diabetes, because of these patients' compromised vasculature. TCCs are, however, vulnerable to bacterial infection and thrombogenesis. Saxena et al. assessed the efficacy of the cephalosporin cefotaxime as an antibiotic lock in preventing TCC-related infection and thrombosis in hemodialysis patients with diabetes.

The 96 patients enrolled in the study were randomly allocated to one of two groups; 49 patients (51 TCCs) received a catheter lock composed of 10 mg/ml cefotaxime and 5,000 U/ml heparin, and 47 patients (58 TCCs) received a standard heparin solution. The cefotaxime group had higher thrombosis-free (86.3% vs 63.8%; P = 0.023), infection-free (72.9% vs 27.1%; P = 0.004) and thrombosis-free and infection-free (78.4% vs 37.9%; P = 0.001) TCC survival than the heparin-alone group. The rate of catheter-related bloodstream infections (CRBSIs) was considerably lower in the cefotaxime group (1.56 vs 3.68 episodes per 1,000 catheter days; P <0.0001), as was mortality from CRBSI (9.8% vs 23.4%; P = 0.015). Cefotaxime was more effective against Gram-negative bacilli than against Gram-positive bacteria; of the 29 incidents of CRBSI in the cefotaxime group, 19 were caused by Gram-positive organisms.

The authors conclude that cefotaxime is effective in preventing bacterial infections and related thrombosis in TCCs of patients with diabetes. Although no resistance to cefotaxime was observed in this study, longer-term trials are required to assess the risk of the development of microbial strains resistant to this cephalosporin.