Antibiotic lock versus systemic antibiotic in catheter related infections in immunocompromised pediatric patients课件.ppt

Antibiotic lock versus systemic antibiotics for catheter related infections in immunocompromised pediatric patients. Ewelina Mamcarz M.D., Divya-Devi Joshi M.D. Objectives Describe indications for systemic antibiotics versus antibiotic lock therapy Evaluate type of antibiotic and treatment duration for antibiotic lock Timing of the antibiotic lock: early/late Antibiotic lock as prevention of catheter associated bacteremia Background: Catheter related infections Leading cause of morbidity and mortality in critically ill hospitalized patients Organisms: Coagulase – negative staphylococci Staphylococcus aureus Gram-negative bacteria Candida ssp. Sources of infection Colonization from the skin Intraluminal / hub contamination Hematologic seeding Clinical evaluation -CRI Local inflammation Sepsis Blood culture Catheter dysfunction Rapid improvement following catheter removal Treatment Type of device Infecting pathogens Presence of alternative venous access sites Duration of anticipated need for access Treatment Catheter removal Systemic antibiotics Antibiotic lock therapy (ALT)- little evidence to support recommendation Data Guidelines from the Infectious Diseases Society of America (IDSA): CRI documented, pathogen identified-narrow spectrum systemic abx and consider ALT Onder at al: timing of antbc locks: ALT more effective early in therapy, diminished need for catheter removal Pervez at al: ALT for prevention of CRI: decreased incidence of CRI, improved survival of catheters Antibiotic lock First publication 1988-Messing et al Higher concentration, longer duration of activity at the infected site without potential side-effects of systemic exposure Concentration and intra-luminal dwell time: lack of evidence based recommendations Lack of firm recommendations for individual patients Immunocompromised population Pathogenesis of CRI complicated Virulence of the pathogens variable Host factors not well defined Lack of diversity between studied populations Absenc