Effectiveness of Antimicrobial Lock Therapy for the Treatment of Catheter-Related and Central-Line-Associated Bloodstream Infections in Children: A Single Center Retrospective Study

Abstract

Antimicrobial lock solutions (ALT) in combination with systemic antibiotics can represent a valid option to attempt central venous catheter (CVC) salvage in the case of catheter-related and central-line-associated bloodstream infections (CRBSI and CLABSI). However, data concerning the effectiveness and safety of ALT in children are limited. We aimed to share our center’s experience in order to contribute to investigations into the causes of ALT failure in the pediatric population. All children consecutively admitted to Meyer Children’s Hospital, University of Florence, Italy, from 1 April 2016 to 30 April 2022, who received salvage ALT to treat an episode of CRBSI/CLABSI, were reviewed. According to ALT failure or success, children were compared with the aim of identifying the risk factors for unsuccessful ALT outcome. Data from 28 children, 37 CLABSI/CRBSI episodes, were included. ALT was associated with clinical and microbiologic success in 67.6% (25/37) of children. No statistically significant differences were observed between the two groups, successes and failures, considering age, gender, reason for use, duration, insertion, type and presence of insertion site infection of the CVC, laboratory data and number of CRBSI episodes. Nevertheless, a trend towards a higher success rate was observed for a dwell time of 24 h for the entire duration of ALT (88%; 22/25 vs. 66.7%; 8/12; p = 0.1827), while the use of taurolidine and the infections sustained by MDR bacteria were associated with a tendency toward greater failure (25%; 3/12 vs. 4%; 1/25; p = 0.1394; 60%; 6/10 vs. 33.3%; 8/24; p = 0.2522). No adverse events, except one CVC occlusion, were observed. ALT combined with systemic antibiotics appears to be an effective and safe strategy for treating children with CLABSI/CRBSI episodes.

Novel Antibacterial Agents SAAP-148 and Halicin Combat Gram-Negative Bacteria Colonizing Catheters

“…However, conjugates of SAAP-148 and halicin could overcome several limitations encountered by the combinations. Regarding non-invasive usage, (combinations or conjugations of) SAAP-148 and halicin may be considered for antibiotic lock therapy [120,121], where (i) the catheter can be coated with the agents encapsulated in a polymeric formulation, such as hydrogel-loaded peptides and peptide-releasing hydrogels [122][123][124], or (ii) the agents may be immobilized on the surface of the catheter [122]. The use of antimicrobial agents as a coating is the most popular approach owing to their ability to target microorganisms in different ways [125].…”

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

“…In hemodialysis patients with established CRBSI, the adjunctive use of ALT was shown to be superior to systemic antibiotics alone in treatment of CRBSI ( 44 ). Data from Pediatric hemodialysis patients also shows that ALT is a viable option for attempting catheter salvage in CRBSI ( 45 ). The challenges with effective treatment of CRBSI in hemodialysis patients likely reflects the issues with achieving therapeutic antibiotic concentrations to successfully eliminate microbial biofilms on the surfaces of catheters ( 41 , 46 ).…”

“…Antibiotics are often mixed with heparin to help maintain lumen patency while the solution dwells. The mixture compatibility and stability are important factors in determining efficacy of antibiotic lock solutions ( 37 , 45 , 52 , 57 – 60 , 61 , 62 , 63 ). The ultimate choice of ALT depends on the microorganisms recovered on blood culture and their sensitivies to antibiotics.…”