Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

摘要

Background: The use of indwelling Central Venous Access Devices (CVADs) is associatedwith the development of bloodstream infections. When CVADs are used to administer systemicantibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developingClostridium difficile infection. The overall bloodstream infection rate is estimated to bearound 1.74 per 1000 Central Venous Catheter (CVC)-days.Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine(cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment viaCVADs.Method: A small case series is described of adult patients who received regular intravenous antibiotictreatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; thisrepresented a total of 357 CVC-days. In addition to following well-established strategies to prevent C.difficile infection, during the course of the intravenous antibiotic treatment the patients also receiveddaily oral supplementation with 4 g colestyramine.Results: There were no untoward infectious events. In particular, none of the patients developed anysymptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infectionwould have been expected.Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infectionthrough its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins areable to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibodyresponses to TcdA and TcdB have been shown to induce protection against C. difficile infectionsequelae.