Maya ID et al. (2007) Treatment of dialysis catheter–related Staphylococcus aureus bacteremia with an antibiotic lock: a quality improvement report. Am J Kidney Dis 50: 289–295

The success of using antibiotic lock solutions for treating catheter-related bacteremia without the need for catheter removal varies depending on the infecting organism, with Staphylococcus aureus infections associated with a high failure rate.

Maya et al. studied about 450 hemodialysis patients in Alabama, USA. An antibiotic lock protocol was administered in all catheter-dependent patients with suspected bacteremia (i.e. those with fever >38 °C or rigors). The protocol involved empiric administration of broad-spectrum systemic antibiotics (subsequently adjusted on the basis of blood culture results) in conjunction with instillation of an antibiotic–heparin solution into the catheter lumen after each dialysis session, for 3 weeks.

In total, 113 patients had a first episode of S. aureus catheter-related bacteremia. Treatment failure necessitating catheter removal occurred in 67 patients (59%), 40 of whom had a persistent fever 2–3 days after initiation of antibiotic therapy (i.e. by the next dialysis session), and 27 of whom had recurrent bacteremia within 90 days of resolution of their initial fever. Only 46 patients (41%) were, therefore, considered to have achieved a clinical cure. Serious complications occurred in 10 (25%) of the 40 patients with persistent fever, but in only 1 of the other 73 patients (1.4%; P <0.0001). Six months after the initial infection, patient survival was similar in individuals with either type of treatment failure and in those who achieved a cure.