1. Katherine Gerrald, PharmD Candidate 1 ; Anne Hishon, PharmD Candidate 1 ; P. Brandon Bookstaver, PharmD, BCPS 2 1 University of South Carolina, College of Pharmacy, Columbia, SC; 2 South Carolina College of Pharmacy, USC Campus, Columbia, SC Treatment Outcomes of Novel Antibiotic Lock Solutions: A Case Series Analysis

2. Catheter Related Bloodstream Infection (CRBSI) An estimated 35,000 CRBSIs occur yearly Mortality rates range from 12-35% 1 Common CRBSI pathogens 2  Coagulase-negative Staphylococcus sp. (CoNS)  Staphylococcus aureus  Aerobic gram negative bacilli  Candida albicans Biofilms provide a challenge to eradicating CRBSIs ¹CDC. Am J Infect Control 1998;26:522-33. 2 Mermel LA, et al. Clin Infect Dis 2001:32 (1 May):1249-1272.

3. Antibiotic Lock Therapy (ALT) High concentrations of antibiotic +/- anticoagulant  100-1000x > MIC Selection based on causative organism

4. ALT Literature National guidelines state:  “Antibiotic lock therapy is recommended for treatment when the catheter is retained.” [B-III] 1 ALT has been shown to shorten hospital stay 2 1 Mermel LA, et al. Clin Infect Dis 2001;32:1249-72 2 Bestul MB, et al. Pharmacother 2005;25:211-27

5. Objective Evaluate the outcomes of various antibiotic lock solutions used for treatment of CRBSIs

6. Methods Retrospective Case Analysis Inclusion:  ALT >24 hours  Treatment of CRBSI Primary Endpoint:  Catheter sterilization at 30 days Secondary Endpoint:  Catheter survival

7. Demographic Data Number of cases 27 Age, mean 12.75 yr range 1mo-82yr Males, n (%) 9(60) Females, n (%) 6(40) Med-Onc service, n (%) 5(33) Pediatric service, n (%) 7(47) Adult IM service, n (%) 3(20) Indication for Central Line

8. Results 74% success in catheter sterilization 52% of catheters were successfully salvaged

9. Results Antibioticn Catheter Sterilization Catheter Salvage Daptomycin6100%83.3% Gentamicin7100%42.8% Vancomycin837.5%50% Ethanol1100%0% Vancomycin + Ethanol 250% Vancomycin + Gentamicin 366%33.3%

10. Results Organismn Catheter Sterilization Catheter Salvage MSSA10% MRSA580%60% CoNS887.5% Enterococcus sp.20% Streptococcus sp.1100%0% GNRs785%28.6% Polymicrobial366.7%

11. Conclusion Successful as addition to systemic antimicrobial therapy in achieving catheter sterilization and salvage Lock solutions containing gentamicin or daptomycin were most successful in catheter sterilization Enterococcus species difficult to eradicate without catheter removal Duration of therapy is unclear Prospective trials needed

12. Katherine Gerrald, PharmD Candidate 1 ; Anne Hishon, PharmD Candidate 1 ; P. Brandon Bookstaver, PharmD, BCPS 2 1 University of South Carolina, College of Pharmacy, Columbia, SC; 2 South Carolina College of Pharmacy, USC Campus, Columbia, SC Treatment Outcomes of Novel Antibiotic Lock Solutions: A Case Series Analysis