1. ¹Department of Medicine, Division of Nephrology, King Fahad Hospital & Tertiary Care Center, King Faizal University, AL-HASA, 31982, Saudi Arabia
2. ²Department of Microbiolgoy, King Fahad Hospital & Tertiary Care Center, King Faizal University, AL-HASA, 31982, Saudi Arabia
3. ³Department of Family Medicine, King Fahad Hospital & Tertiary Care Center, King Faizal University, AL-HASA, 31982, Saudi Arabia

Correspondence: AK Saxena, Department of Medicine, Division of Nephrology, Sheikh Khalifa Medical City (SKMC), PO Box 51900, Abu Dhabi, United Arab Emirates. E-mail: dranil_31982@yahoo.com

Received 17 February 2006; Revised 13 May 2006; Accepted 13 June 2006; Published online 6 September 2006.

Abstract

Efficacy and safety of antibiotic 'locks', in prevention of thrombotic and infectious complication-related morbidity and mortality, among diabetics dialyzed through tunneled-cuffed catheters (TCCs) has not been effectively investigated. This trial was designed to investigate the outcome of TCCs (n=109), inserted among 96 diabetic end-stage renal disease patients (March 2002–February 2003), by comparing the catheter thrombosis, catheter-related bloodstream infections (CRBSI), catheter survival, and mortality rates, between the cohorts of 49 patients who had TCCs (n=51) 'locked' with cefotaxime/heparin (group I) and 47 patients with TCCs (n=58) filled with standard heparin (group II). Thrombosis was defined as the inability to use catheter at a blood flow of 200 ml/min despite intraluminal thrombolysis. Primary end points were catheter thrombosis and CRBSI; elective catheter removal and CRBSI-related death led to sensor of TCCs follow-up. Patients with intraluminal cefotaxime/heparin lock, on cumulative survival analysis, showed a superior thrombosis-free (86.3 vs 63.8%, P=0.023, log rank), infection-free (72.9 vs 27.1%, P=0.004, log rank), and thrombosis- and infection-free TCC survival (78.4 vs 37.9%, P=0.001, log rank) at 365 days, besides having significantly lower incidence of CRBSI (1.56 vs 3.68 episodes/1000 catheter days, P<0.0001) and CRBSI-related mortality (9.8 vs 23.4%, P=0.015), compared with the heparin-alone group. Deployment of cefotaxime–heparin 'lock' enhances catheter survival; reduces thrombotic and infectious complications and ensuing mortality, among diabetics on dialysis. However, further studies are needed to define the long-term implications of antibiotic locks in terms of the risk of emergence of antimicrobial resistance.