Poređenje antimikrobnih i trombolitičkih rastvora za zatvaranje centralnih venskih katetera u prevenciji komplikacija povezanih sa kateterima kod bolesnika na hemodijalizi: randomizovano kontrolisano ispitivanje
Sažetak
Uvod/Cilj. Centralni venski kateteri (CVK) kod bolesnika na hemodijalizi (HD) povezani su sa ozbiljnim komplikacijama, posebno bakterijemijom povezanom sa kateterom (BPSK) i trombozom, što dovodi do povećanog morbiditeta i mortaliteta. Cilj rada bio je da se proceni efikasnost tri različita rastvora za zatvaranje katetera u sprečavanju većih komplikacija povezanih sa kateterom. Metode. Ova prospektivna, randomizovana, kontrolisana studija sprovedena u jednom centru, od juna 2018. do juna 2023. godine, obuhvatila je 96 odraslih bolesnika na HD. U zavisnosti od rastvora koji su primali, bolesnici su bili ravnomerno podeljeni u tri različite grupe: gentamicin–citrat dva puta nedeljno uz taurolidin/urokinazu nakon treće nedeljne dijalize (TAURO); gentamicin–citrat tri puta nedeljno (GENTAM); nefrakcionisani heparin 5 000 internacionalnih jedinica/mL tri puta nedeljno (HEPARIN). Rastvori za zatvaranje katetera su primenjivani najmanje tri meseca nakon plasiranja CVK i njihova primena je nastavljena do uklanjanja katetera. Praćeni ishodi obuhvatali su incidenciju BPSK, trombozu katetera i neželjene događaje. Rezultati. Tokom 10 770 „kateter-dana“ registrovano je osam epizoda BPSK, a najčešći uzročnik bio je Staphylococcus aureus (50%). Incidencija BPSK (na 1 000 „kateter-dana“) bila je 0,27 u TAURO grupi, 0,83 u GENTAM grupi i 1,15 u HEPARIN grupi, bez statističke značajnosti (p = 0,526). Incidencija tromboze katetera bila je slična u svim grupama (1,09–1,15; p = 0,990). Koksova analiza proporcionalnih rizika nije pokazala značajne razlike, iako je TAURO grupa pokazala trend ka manjem riziku od BPSK u poređenju sa HEPARIN grupom (hazard ratio = 0,236; 95% interval poverenja 0,026–2,116). Zaključak. Nijedan ispitivani režim rastvora za zatvaranje katetera nije značajno smanjio rizik od BPSK ili tromboze. Ipak, najniža incidencija BPSK zabeležena je u TAURO grupi, što ukazuje na potencijalnu korist koju treba potvrditi u većim, multicentričnim studijama.
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