INTRALUMINAL ANTIBIOTIC-TREATMENT OF CENTRAL VENOUS CATHETER INFECTIONS IN PATIENTS RECEIVING PARENTERAL-NUTRITION AT HOME

We carried out an open, uncontrolled, prospective study to evaluate in traluminal antibiotic therapy for bloodstream infections arising from subcutaneously tunneled central venous catheters in patients receiving parenteral nutrition therapy at home. Seven bacterial infections were treated with intraluminal antibiotics (mean duration, 8.6 days) somet imes accompanied by systemic antibiotics (mean duration, 2.1 days). Al l seven infections were cured. Two infections caused by Candida specie s were treated with intraluminal amphotericin B. Fungal infection was suppressed during treatment but later relapsed, as confirmed by pulsed field DNA electrophoresis typing of bloodstream isolates. The concent ration of antibiotic was assayed in intraluminal fluid from catheters of patients receiving treatment with vancomycin or gentamicin, The con centration was initially similar to 5 mg/mL, and it remained at greate r than or equal to 2.5 mg/mL throughout the period that the solution w as locked in the catheter. Our findings show that intraluminal therapy is effective against selected bacterial infections and can suppress f ungal infections in subcutaneously tunneled catheters.