Vancomycin-lock therapy for prevention of catheter-related bloodstream infection in very low body weight infants

Abstract

Background: 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.

Methods: One 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.

Results: The 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.

Conclusions: Vancomycin-lock may effectively prevent CRBSI in Chinese VLBW preterm infants and reduce the exposure time of antibiotics, without causing obvious side complications.

Keywords: Catheter-related bloodstream infection; Lock; Preterm infants; Prevention; Vancomycin; Very low body weight.

Fig. 1

Patient selection flowchart. PICC, peripherally inserted central catheters; UVC, umbilical venous catheters

Fig. 2

Kaplan-Meier survival curve analysis of the probability of non-CRBSI in the vancomycin-lock and control groups. The probability (log rank (mantel-cox)) of non-CRBSI was significantly larger in the vancomycin-lock group at each same time point after the baseline (i.e. day 10, 20, 30, and 40) (p < 0.001). The numbers of patients without CRBSI in the vancomycin-lock and control groups were 68 vs 69 at day 0, 67 vs 54 at day 10, 59 vs 33 at day 20, 53 vs 26 at day 30, and 50 vs 23 at day 40, respectively