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10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

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Beta-lactam continuous infusion therapy (BLACIT) compared to linezolid or vancomycin in the treatment of catheter-related Staphylococcus aureus blood-stream infections (CRBSI-SA) in hemodialysis patients – a retrospective analysis

Vergleich einer kontinuierlichen Beta-Laktam-Infusionstherapie (BLACIT) versus Linezolid oder Vancomycin in der Behandlung der katheterassoziierten Staphylococcus aureus Bakteriämie bei Hämodialyse-Patienten – eine retrospektive Analyse

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  • T. Treutler - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin, Nephrologie, Leipzig, Germany; Klinikum St. Georg gGmbH, KfH Dialysezentrum, Leipzig, Germany
  • J. Beige - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin, Nephrologie, Leipzig, Germany; Klinikum St. Georg gGmbH, KfH Dialysezentrum, Leipzig, Germany
  • B.R. Ruf - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin, Nephrologie, Leipzig, Germany
  • T. Grünewald - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin, Nephrologie, Leipzig, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP64

doi: 10.3205/10kit120, urn:nbn:de:0183-10kit1202

Published: June 2, 2010

© 2010 Treutler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: Catheter-related Staphylococcus aureus blood stream infections (CRBSI-SA) are a common problem in patients undergoing hemodialysis (HD). Guideline-derived treatments using vancomycin poses several problems with regard to efficacy and toxicity. Continuous infusion of ß-lactam antimicrobial agents offers an attractive pharmacodynamic approach towards controlled application of those drugs.

Goal: Analysis of a retrospective case series to compare clinical, microbiological outcomes and adverse events in HD patients with CRBSI-SA.

Patients and Methods: HD patients with documented CRBSI-SA in a large tertiary dialysis referral centre (n=25) were treated with either vancomycin intermittent i.v. (trough level guided, VAN, n=8), linezolid 600 mg bid i.v. (LIN n=5) or flucloxacillin BLACIT (initial bolus 4 grams, then 4 grams/12 hours continuously in combination with rifampin 0.6 g/d (FLU/RIF, n=12) for 10–14 days. All catheters were removed immediately after diagnosing CRBSI-SA. Surveillance blood cultures were obtained at day seven and at the end o treatment period. Clinical efficacy and adverse events were monitored at least thrice-weekly.

Results: With respect to the clinical and microbiological efficacy no differences between the treatment groups were detected. Median time to defeverescence was to 2–3 days in all groups, blood cultures were negative in all patients by day seven and at the end of treatment. In neither patient selection of MRSA was detected. No severe adverse events were recorded. No secondary infectious sequelae directly related to CRBSI-SA (infective endocarditis, spondylodiscitis) were noted.

Conclusions: FLU/RIF combination therapy incorporating BLACIT is a feasible effective and safe treatment option in HD patients with CRBSI-SA. Larger prospective studies have to confirm these results with respect of vancomycin restriction in HD patients and should evaluate the impact of such treatments on colonization with resistant pathogens (e.g. VRE).

Conflict of Interest: None.