ANTIBIOTIC LOCK TECHNIQUE WITH TEICOPLANIN FOR CONTROL OFSTAPHYLOCOCCUS CENTRAL VENOUS CATHETER-RELATED SEPSIS IN CHILDREN WITH LONG TERM HOME PARENTERAL NUTRITION

Abstract

229 Catheter-related sepsis is the most frequent complication during home parenteral nutrition. It is usually treated with systemic and prolonged antibiotic therapy in hospital. The aim of this study was to evaluate the efficacy of the antibiotic lock technique with teicoplanin in combination with a short term systemic antibiotic therapy in children with documentedStaphylococcus catheter-related sepsis. Patients and methods: All patients treated with home parenteral nutrition presenting with clinical sepsis and one or more positive blood cultures were included. They were treated for 15 days with antibiotic lock associated with a systemic antibiotic therapy during the first 5 days administered through the catheter (teicoplanin and amikacine). The antibiotic lock consisted of teicoplanin (0.3 ml, 40 mg) and heparin (0.2 ml, 20 UI). Intracatheter antibiotic lock was replaced every morning just at the end of nocturnal cyclic parenteral nutrition and left in over a period of 12 hours. The fluid was aspirated every evening before cyclic parenteral nutrition. Efficacy criteria were: clinical improvement (fever), negative blood cultures at 3 and 5 days and C reactive protein (CRP) profile. Results: Seventeen patients aged 5 to 59 months(median: 29 months) were prospectively included. All Staphylococcus strains were sensitive to teicoplanin. Before treatment, CRP values ranged from 3 to 130 mg/L (mean ± 1 SD: 39 ± 34 mg/L). After 2 days of treatment, CRP values ranges from 17 to 48 mg/L (mean ± 1 SD: 27± 19 mg/L). After starting antibiotic therapy, mean time for temperature and CRP normalizations were 2.4 days (range 1 to 6 days) and 5.6 days (range 3 to 12 days), respectively. Only one blood culture was still positive after 3 days of treatment. All control cultures were negative after 5 days of treatment as well as 48 hours after the completion of treatment. No removal of catheter was necessary. No adverse reaction attribuable to teicoplanin was noted throughout the study period. Conclusion: Treatment of venous catheter sepsis with in situ teicoplanin is effective in eradicating Staphylococcus infection. Advantages of this treatment are diminishing the duration of systemic antibiotic treatment and allowing pursuit of cyclic parenteral nutrition. It may lead to a shortest hospital stay since the last 10 days of therapy could be pursued by trained parents at home.