Antibiotic lock therapy for the treatment of catheter-related bloodstream infections (CRBSI) in maintenance hemodialysis patients with long-term intravascular catheters

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  • 透析患者の長期留置型カテーテルに合併したカテーテル関連血流感染症に対する抗生剤ロック療法の経験
  • 症例報告 透析患者の長期留置型カテーテルに合併したカテーテル関連血流感染症に対する抗生剤ロック療法の経験
  • ショウレイ ホウコク トウセキ カンジャ ノ チョウキ リュウチガタ カテーテル ニ ガッペイ シタ カテーテル カンレン ケツリュウ カンセンショウ ニ タイスル コウセイザイ ロック リョウホウ ノ ケイケン

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Abstract

We report two cases of catheter-related bloodstream infection (CRBSI) in maintenance hemodialysis patients with long-term intravascular catheters. Both cases were successfully treated with antibiotic lock therapy. Case 1 : The patient was a 56-year-old man who started hemodialysis 12 years earlier due to diabetic nephropathy. A long-term intravascular catheter was inserted from the left subclavian vein 6 months prior to presentation. He initially presented with a complaint of high fever and was admitted to our hospital for management. During the hospital course, he was diagnosed with CRBSI caused by methicillin-susceptible Staphylococcus aureus (MSSA). We successfully treated him with intravenous cefazolin (CEZ) and vancomycin (VCM) lock therapy for 4 weeks. Case 2 : The patient was a 72-year-old woman who was bed-ridden secondary to rheumatoid arthritis. She had been admitted to our hospital with pneumonia and uremia 3 months earlier. A long-term intravascular catheter was inserted from the right internal jugular vein. She complained of a high fever and was diagnosed with CRBSI caused by methicillin-resistant Staphylococcus epidermidis (MRSE). We successfully treated her with intravenous VCM and VCM lock therapy for 2 weeks. These two cases suggest that in the cases where removing a long-term intravascular catheter may be difficult, a combination of intravenous antibiotics and antibiotic lock therapy may be used to adequately treat the infection and allow retention of the catheter.

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