December 1, 2007

EIN: Antibiotic Locks Common, But No Common Protocol

A large number of clinicians are using antimicrobial locks to prevent or treat catheter-related bloodstream infections, but techniques vary widely, according to a new survey of the Emerging Infections Network (EIN). This result—coupled with significant interest expressed in the subject by EIN members —suggest the need to develop standardized protocols for the use of the locks.

More than 40 percent of respondents to the survey said they used antimicrobial lock therapy (ALT) to salvage infected catheters, most frequently to combat coagulase-negative staphylococcal infections. Vancomycin, often combined with heparin, was the most commonly used antimicrobial, but a wide range of other antimicrobials were reported. Concentrations, durations, and dwell times varied.

More than half of nearly 1,100 EIN members receiving the survey responded—an extremely high response rate. Many others who did not respond expressed interest in the findings.

Several respondents reported their pharmacists had drug compatibility concerns, particularly with the combination of vancomycin and heparin. Some used ethanol solutions, but there was concern that ethanol would damage the catheter.

“We found antimicrobial locks are used fairly often, especially for treating the most common infections,” said EIN Program Coordinator Susan Beekmann, RN, MPH, “but there is no standard method.” Developing standardized protocols would help both clinicians and pharmacists optimize the procedure, she said.

EIN conducted the survey following requests from several members and from the Centers for Disease Control and Prevention. Survey results will be shared with the IDSA and Society for Healthcare Epidemiology of America panel currently working on guidelines for health care-acquired infections, which are expected next year.

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