Buradasınız

HEMODİYALİZ HASTALARINDA ÇİFT LÜMENLİ KATETERE BAĞLI İNFEKSİYONLARIN ÖNLENMESİNDE SEFAZOLİN İÇEREN HEPARIN SOLÜSYONUNUN ETKİSİ

THE EFFECT OF CEFAZOLIN CONTAINING HEPARIN SOLUTION FOR PREVENTION OF DOUBLE LUMEN CATHETER RELATED INFECTIONS IN HEMODIALYSIS PATIENTS

Journal Name:

Publication Year:

Abstract (2. Language): 
Double lumen catheters, used as temporary vascular access for hemodialysis, may cause serious infectious complications. Fifty-six patients with end stage renal disease (ESRD) or acute renal failure (ARF), requiring temporary access for hemodialysis, were randomised to receive either 2500 U/ml heparin (H) or 2500 U/ml heparin plus 200 mcg/ml cefazolin (H+C) for catheter lumens to remain between dialysis sessions. There were 30 patients (12 M, 18 F; 20 ESRD, 10 ARF) in the H group and the mean age was 42.5±17.9, whereas there were 26patients (6 M, 20 F; 16 ESRD, 10 ARF) in the H+C group and the mean age was 46.1 ±17.9. There were no significant differences between the two groups for age, gender and the type of renal failure (p>0.05). Catheter remaining times for H and H+C groups were 15.4±13.0 days and 19.5±5.2 days, respectively (p>0.05). Seven catheter exit-site infections, two catheter related sepsis and two catheter related fever were detected in the H group, whereas four exit-site infections and one catheter related fever were found in the H+C group (p>0.05). In conclusion, 200 mcg/ml cefazolin containing heparin solution was not significantly efficient for preventing catheter related infections, but further studies containing more patients with longer catheter remaining times are needed.
Abstract (Original Language): 
Hemodiyaliz uygulaması için geçici damar yolu olarak çift lümenli kateterlerin sık olarak kullanılması ciddi infeksiyonlara neden olabilir. Hemodiyaliz için geçici damar yoluna gereksinimi olan 56 son dönem böbrek yetersizlikti (SDBY) veya akut böbrek yetersizlikti (ABY) hasta kateter tümenlerine diyalizler arası sürede kalmak üzere 2500 Ü/mlheparin (H) veya 2500 Ü/ml heparin ve 200 mcg/ml sefazolin (H+S) içeren solüsyon verilmek üzere tek kör olarak randomize edildiler. Sadece H kullanılan grupta 30 hasta (12 erkek, 18 kadın; 20 SDBY, 10 ABY) mevcut olup yaş ortalaması 42.5±17.9 idi. H+S kullanılan grupta ise 26 hasta (6 erkek, 20 kadın; 16 SDBY, 10 ABY) mevcuttu; yaş ortalaması 46.1 ±17.9 idi. Her iki grup arasında yaş, cinsiyet ve böbrek yetersizliğinin tipi açılarından anlamlı bir farklılık yoktu (p>0.05). Kateter kalış süreleri H ve H+S kullanılan gruplarda sırası ile 15.4±13.0 gün ve 19.5±5.2 gün olarak saptandı (p>0.05). Hkullanılan grupta 7 hastada kateter çıkış yeri infeksiyonu, 2 hastada katetere bağlı sepsis, 2 hastada katetere bağlı ateş, H+S kullanılan grupta ise, 4 hastada kateter çıkış yeri infeksiyonu ve 1 hastada katetere bağlı ateş gelişti (p>0.05). Sonuç olarak, 200 mcg/ml sefazolin içeren heparinli solüsyonun kateter tümenlerinde bırakılmasının katetere bağlı infeksiyonlan önlemede anlamlı bir etkisinin olmadığı, ancak daha uzun süreli kateter kullanılan geniş serilerde konunun araştırılması gerektiği kanısına varıldı.
FULL TEXT (PDF): 
65-68

REFERENCES

References: 

1. Raja RM. Vascular acces for hemodialysis In: Daugirdas TJ, Ing TS (eds), Handbook of Hemodialysis, (2nd ed), Little-Brown, USA, 1994 pp 53-78.
2. Hung KY, Tsai TJ, Yen CJ, Yen TS. Infection associated with double lumen catheteterization for temporary hemodialysis: experience of 168 cases. Nephrol Dial
Transplant 1995; 10: 247-2451.
3. Ranson MR, Oppenheim BA, Jackson A, Kamthan AG, Scarffe JH. Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients. JHosp Inf 1990; 15: 95-102.
4. Lim SH, Smith MP, Salooja N, Machin SJ, Goldstone
AH. A prospective randomised study of prophylactic teicoplanin to prevent early Hickman catheter-related sepsis in patients receiving intensive chemotherapy for haemotological malignancies. J Antimicrob Ch 1991; 28: 109-116.
5. Bock SN, Lee RE, Fisher B, et al. A prospective randomised trial evaluating prophylactic antibiotics to prevent triple lumen catheter-related sepsis in patients treated with immunotherapy. J Clin Oncol 1990; 1:161¬169.
6. Centers for disease control and prevention. Draft guideline for prevention of intravascular device-related
infections. Fed Regist 1995; 60(187): 49978-50006.
67
7. Dahlberg PJ, Yutuc WR, Newcomer KL. Subclavian hemodialysis catheter infections. Am J Kidney DİSİ986; 5:421-427.
8. Root JL, Mclntyre OR, Jacobs NJ, Daghlian CP.
Inhibitory effect of disodium EDTA upon the growth of staphylococcus epidermidis in vitro: Relation to infection prophylaxis oh hickman catheters. Antimicrob Agents Ch 1988; 11:1627-1631.
9. Montagnac R, Schillinger F. Rifampicin-protamine protocol applied for prevention of central catheter sepsis in hemodialysis. Nephrol Dial Transplant 1993; 8(3): 289-290.
10. Al-Sibai MB, Harder EJ, Faskin WR, Johnson GW,
Padmos MA. The value of prophylactic antibiotics during the insertion of long term indwelling silastic right atrial catheters in cancer patients. Cancer 1987; 60: 1891-1895.
11. Schwartz C, Henrickson KJ, Roghmann K, Powell K. Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms. J Clin Oncol 1990; 8:1591-1597.
12. Spafford PS, Sinkin RA, Cox C, Reubens L, Powwel
KR. Prevention of central venous catheter-related coagulase-negative staphylococcal sepsis in neonates. J
Pediatrl994; 125:259-263.
13. Barefield ES, Philips III JB. Vancomycin prophylaxis for coagulase negative staphylococcal bacteremia. J
Pediat 1994; 125: 230-232.
14. Cooper GL, Hopkins CC. Rapid diagnosis of intravascular catheter associated infection by direct Gram staining of catheter segments. N Engl J Med 1985;
312: 1142-1147.
15. De Cicco M, Panarello G, Chiardia V, et al. Source and route of microbial colonisation of parenteral nutrition
catheters. Lancet 1989; 2:1258-1261.
16. Linares J, Sitges-Serra A, Garau J, Perez JL, Martin R. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter
hub and segments. J Clin Microbiol 1985; 21: 357-360.
17. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement.
J Infect Dis 1993; 163: 400-407.
68

Thank you for copying data from http://www.arastirmax.com