Abstract
BackgroundThis study was to evaluate the effectiveness and safety of vancomycin- lock therapy for the prevention of catheter-related bloodstream infection (CRBSI) in very low body weight (VLBW) preterm infant patients.MethodsOne hundred and thirty-seven cases of VLBW preterm infants who retained peripherally inserted central catheters (PICCs) were retrospectively reviewed, including 68 treating with heparin plus vancomycin (vancomycin-lock group) and 69 with heparin only (control group). The incidence of CRBSI, related pathogenic bacteria, adverse events during the treatment, complications, antibiotic exposure, PICC usage time, hospital stay, etc. were compared between the above two groups.ResultsThe incidence rate of CRBSI in the vancomycin-lock group (4.4%, 3/68) was significantly less than in the control group (21.7%, 15/69, p = 0.004). Total antibiotic exposure time during the whole observation period was significantly shorter in the group than in the control group (11.2 ± 10.0 vs 23.6 ± 16.1 d; p < 0.001). No hypoglycemia occurred during the locking, and the blood concentrations of vancomycin were not detectable.ConclusionsVancomycin-lock may effectively prevent CRBSI in Chinese VLBW preterm infants and reduce the exposure time of antibiotics, without causing obvious side complications.
Highlights
This study was to evaluate the effectiveness and safety of vancomycin- lock therapy for the prevention of catheter-related bloodstream infection (CRBSI) in very low body weight (VLBW) preterm infant patients
After exclusion of 1836 cases with birth weight > 1.8 kg, 20 dead during the first week after birth, 27 dead for severe complications, 12 transferred to other hospitals, 114 requiring UVCs, and 84 requiring neither UVC nor Peripherally inserted central catheter (PICC), 183 infant patients were further reviewed, including 90 receiving vancomycin-lock and 93 receiving heparin only. After another exclusion of cases with PICC duration
It appeared that eventually the numbers of subjects in the vancomycin- and heparin-lock groups were similar, while as a retrospective study, the cases were not randomized to the two groups
Summary
This study was to evaluate the effectiveness and safety of vancomycin- lock therapy for the prevention of catheter-related bloodstream infection (CRBSI) in very low body weight (VLBW) preterm infant patients. Antibiotic-lock therapy (ALT) has been developed that high-dose antibiotic solution dripped and maintained in the catheter cavity for a certain period can dissolve the biofilm formed on the wall to reduce the colonization of the bacteria and kill the embedded bacteria. Viale et al demonstrated that most (93.3%) patients carrying central line, who received antibiotic locks alone or locks plus systemic antibiotics therapy, successfully retained the central catheter, without the incidence of CRBSI and treatment-related adverse events [13]. Megged et al showed combination of ALT with systemic antibiotics just achieved limited preventive effect on the central venous CRBSI in children [18]
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