Parte III. Terapia de sellado antimicrobiano, citrato y otras alternativas en la prevención de la infección de los catéteres venosos centrales de hemodiálisis

Abstract

Although arteriovenous fistula is the recommended vascular access for chronic hemodialysis, still high numbers of patients receiving dialysis through tunneled hemodialysis catheters are observed in Chile. Several studies have demonstrated the usefulness for preventing catheter-related bacteremia (CRB) associated to tunnelled hemodialysis catheters by antibiotic lock prophylaxis between dialysis. However, there is no consensus regarding its systematic use. In this review the existing evidence is discussed, emphasizing the group of patients where this prophylaxis could have mayor impact as those with high risk for recurrent infections: immunesuppressed, diabetics, and specially those without vascular reserve. Lock-prophylaxis can also be recommended in centers where a high rate of CBR persists despite an appropriate intervention with standard management. Antibiotics can also be used for therapeutic purposes (lock-therapy) during CBR in selected patients such as those without vascular reserve affected by low-virulent microorganisms avoiding catheter withdrawal. It is recommended that in these cases, antibiotic lock therapy be combined with systemic antibiotic therapy. High cure rates has been observed in CRB provoked by gram-negative microorganisms (up to 87%), but limited for Staphylococcus aureus CRB (about 50%).