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Antibiotic-Lock Technique: A New Approach to Optimal Therapy for Catheter-Related Sepsis in Home-Parenteral Nutrition Patients

INSERM U.290 et Clinique Gastroentérologique, Centre agréé de Nutrition Parentéral à Domicile, Hôpital Saint-Lazare, Paris, France

Sophie Peitra-Cohen, M.D.

INSERM U.290 et Clinique Gastroentérologique, Centre agréé de Nutrition Parentéral à Domicile, Hôpital Saint-Lazare, Paris, France

Alain Debure, M.D.

INSERM U.290 et Clinique Gastroentérologique, Centre agréé de Nutrition Parentéral à Domicile, Hôpital Saint-Lazare, Paris, France

Martine Beliah, R.N.

INSERM U.290 et Clinique Gastroentérologique, Centre agréé de Nutrition Parentéral à Domicile, Hôpital Saint-Lazare, Paris, France

Jean-Jacques Bernier, M.D.

INSERM U.290 et Clinique Gastroentérologique, Centre agréé de Nutrition Parentéral à Domicile, Hôpital Saint-Lazare, Paris, France

During a cumulated survey of 286 months, covering 11 gastroenterological patients under nocturnal-cyclic home parenteral nutrition, 24 cases of catheter-related sepsis were observed (one/11.9 months). None of these were associated with focus of infection at the cutaneous entry point or at the subcutaneous tunnel of the catheters. In this study attempt was made to control sepsis without removal of the surgically implanted siliconed lines (Vygon code 180-20 with an internal filling volume of 1 ml). The first two catheter-sepsis were conventionally treated with systemic antibiotics for 3 weeks which meant a 1-month hospital admission each time. Consequently, we used a new antibiotic therapy consisting of locking 12 hr/day 2 ml of highly concentrated antibiotic solution within the catheter. After identification of bacterial strains by blood cultures, the antibiotic lock-technique was daily applied either alone for 16 days (group I, n = 11) or for 12 days following a 3-day course of systemic antibiotics (group II, n = 11). After starting antibiotics via the infected line, the time taken for fever abatement and for obtaining negative in-line blood cultures were 2 and 4 days, respectively, and identical in group I and II. Failure of antibiotic treatment leading to catheter withdrawal was observed once in each group (9% ) and was due to secondary candida catheter-sepsis. The time for hospital stay was shorter p < 0.02 in group I (4 days) than in group II (7 days). Antibiotic-lock technique was then applied by trained patients at home. This study demonstrates that catheter-related sepsis due to septic manipulation of the nutritive line is nearly always successfully treated by antibiotic-lock technique. Therefore this new approach represents an improved therapy avoiding hazards of catheter change and systemic antibiotic therapy. (Journal of Parenteral and Enteral Nutrition 12:185-189, 1988)

Journal of Parenteral and Enteral Nutrition, Vol. 12, No. 2, 185-189 (1988)
DOI: 10.1177/0148607188012002185


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