Antibiotic management of infected vascular access

Juan Lemus, Héctor Parra and Adriana Undurraga

Hospital de la Fuerza Aérea, Santiago de Chile

Sir,

We would like to make the following comments on the recently published article by Peleman et al. [1] in Nephrology Dialysis Transplantation.

First, the authors did not make a distinction between care of ambulatory patients and those who were hospitalized. Second, they did not make a distinction between patients with or patients without particular risk factors for infection [2].

In our opinion, infections in patients with acute renal failure preclude the use of gentamicin. We recommend the use of ciprofloxacin in this setting.

Fogel et al. [3] recommend the use of cefazolin for out-patients, whereas Peleman et al. omitted this suggestion. Do they think that this drug should not be given?

We doubt that the recommendation on catheter salvage in a rather limited number of cases (n=13) has any statistical value.

References

  1. Peleman RA, Vogelaers D, Verschraegen G. Changing patterns of antibiotic resistance update on antibiotic management of infected vascular access. Nephrol Dial Transplant2000; 15: 1281–1284[Free Full Text]
  2. Canaud B. Haemodialysis catheter related infection: time for action. Nephrol Dial Transplant1999; 14: 2288–2290[Free Full Text]
  3. Fogel MA, Nussbaum PB, Feintzeig ID, Hunt WA, Gavin JP, Kim RC. Cefazolin in chronic hemodialysis patients: a safe, effective alternative to vancomicin. Am J Kidney Dis1998; 32: 401–409[ISI][Medline]




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