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

被引:91
作者
Garland, JS
Alex, CP
Henrickson, KJ
McAuliffe, TL
Maki, DG
机构
[1] St Josephs Hosp, Dept Pediat, Milwaukee, WI USA
[2] Med Coll Wisconsin, Dept Pediat, Milwaukee, WI 53226 USA
[3] Med Coll Wisconsin, Dept Biostat, Milwaukee, WI 53226 USA
[4] Univ Wisconsin, Sch Med, Dept Med, Infect Dis Sect, Madison, WI 53706 USA
关键词
bacteremia; bloodstream infection; central venous catheter/access device; nosocomial infections; premature infants; sepsis; vancomycin;
D O I
10.1542/peds.2004-2674
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective. Critically ill neonates are at high risk for vascular catheter-related bloodstream infection (CRBSI), most often caused by coagulase-negative staphylococci. Most CRBSIs with long-term devices derive 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 heparinized saline that contained vancomycin 25 mu 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, demonstrating concordance by restriction-fragment DNA subtyping. Surveillance axillary and rectal cultures were performed 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 staphylococci were recovered from any cultures. Vancomycin could not be detected in the blood of infants who did not receive systemic vancomycin therapy. Twenty-six neonates (8 vancomycin-lock group, 18 control group) had at the end of a catheter-lock period asymptomatic hypoglycemia that resolved promptly when glucose-containing intravenous fluids were restarted. Conclusions. Prophylactic use of a vancomycin-heparin lock solution markedly reduced the incidence of CRBSI in high-risk neonates with long-term central catheters 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.
引用
收藏
页码:E198 / E205
页数:8
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