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A Vancomycin-Heparin Lock Solution for Prevention of Nosocomial Bloodstream Infection in Critically Ill Neonates With Peripherally Inserted Central Venous Catheters: A Prospective, Randomized Trial

A Vancomycin-Heparin Lock Solution for Prevention of Nosocomial Bloodstream Infection in Critically Ill Neonates With Peripherally Inserted Central Ve

A Vancomycin-Heparin Lock Solution for Prevention of Nosocomial Bloodstream Infection in Critically Ill Neonates With Peripherally Inserted Central Venous Catheters: A Prospective, Randomized Trial   (Citations: 14)
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Objective. Critically ill neonates are at high risk for vascular catheter-related bloodstream infec- tion (CRBSI), most often caused by coagulase-negative staphylococci. Most CRBSIs with long-term devices de- rive from intraluminal contaminants. The objective of this study was to ascertain the safety and the efficacy of a vancomycin-heparin lock solution for prevention of CRBSI. Methods. A prospective, randomized double-blind trial was conducted during 2000-2001 at a community hospital level III NICU. Very low birth weight and other critically ill neonates with a newly placed peripherally inserted central venous catheter were randomized to have the catheter locked 2 or 3 times daily for 20 or 60 minutes with heparinized normal saline (n 43) or hep- arinized saline that contained vancomycin 25 g/mL (n 42). The origin of each nosocomial bloodstream infection (BSI) was studied by culturing skin, catheter hubs, and implanted catheter segments and blood cultures, demon- strating concordance by restriction-fragment DNA sub- typing. Surveillance axillary and rectal cultures were per- formed to detect colonization by vancomycin-resistant organisms. The main outcome measures were (1) CRBSIs and (2) colonization or infection by vancomycin-resistant Gram-positive bacteria. Results. Two (5%) of 42 infants in the vancomycin- lock group developed a CRBSI as compared with 13 (30%) of 43 in the control group (2.3 vs 17.8 per 1000 catheter days; relative risk: 0.13; 95% confidence interval: 0.01-0.57). No vancomycin-resistant enterococci or staph- ylococci were recovered from any cultures. Vancomycin could not be detected in the blood of infants who did not receive systemic vancomycin therapy. Twenty-six neo- nates (8 vancomycin-lock group, 18 control group) had at the end of a catheter-lock period asymptomatic hypogly- cemia that resolved promptly when glucose-containing intravenous fluids were restarted. Conclusions. Prophylactic use of a vancomycin-hepa- rin lock solution markedly reduced the incidence of CRBSI in high-risk neonates with long-term central cath- eters and did not promote vancomycin resistance but was associated with asymptomatic hypoglycemia. The use of an anti-infective lock solution for prevention of CRBSI with long-term intravascular devices has achieved proof of principle and warrants selective application in clinical practice. Pediatrics 2005;116:e198-e205. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-2674; bacteremia, bloodstream infection, central venous catheter/access de- vice, nosocomial infections, premature infants, sepsis, vancomycin.
Published in 2010.
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