Efficacy of a vancomycin solution to prevent bacteremia associated with an indwelling central venous catheter in neutropenic and non-Neutropenic cancer patients

Abstract

We evaluated the efficacy of a vancomycin solution in the prevention of bacteremia caused by vancomycin‐sensitive organisms (VSO) in cancer patients with a tunneled central venous catheter (CVC). Eighty‐three patients who had a single lumen CVC were randomized to use a heparin solution (25 U/ml) for daily catheter flush with (HepVan) or without (Hep) vancomycin, 25 mcg/ml. Febrile episodes were recorded, and central and peripheral blood cultures were drawn before beginning antibiotic therapy. Patients participated in follow‐up for 16,677 catheter days (8,666 Hep and 8,011 HepVan), and 143 febrile episodes were recorded (82 Hep and 61 HepVan). Forty‐four episodes of bacteremia occurred, 23 of them due to VSO (16 occurred in the Hep group and 7 in the HepVan group (P = 0.19). VSO bacteremia occurred in 14 neutropenic (absolute neutrophil count < 500 × 104/l) episodes (7 Hep vs. 7 HepVan) and in 9 non‐neutropenic episodes (9 Hep vs. 0 HepVan; P = 0.013). Vancomycin effectively prevented bacteremia by VSO in non‐neutropenic patients, supporting the idea that intraluminal colonization of indwelling CVCs contributes to bacteremia only in these patients. Med. Pediatr. Oncol. 28:196–200 © 1997 Wiley‐Liss, Inc.

Use of Vancomycin-Containing Lock or Flush Solutions for Prevention of Bloodstream Infection Associated with Central Venous Access Devices: A Meta-Analysis of Prospective, Randomized Trials

“…Seven trials fulfilled inclusion criteria [85][86][87][88][89][90][91]. The characteristics of the included trials are shown in table 1.…”

“…Of the studies that used this criteria, 4 evaluated a vancomycin-heparin lock solution [85,86,88,90], and the remainder evaluated a vancomycin-heparin flush solution. In 2 studies, after a specified time period, the lock solution was aspirated and discarded [85,86]; in the remaining 5 studies [87][88][89][90][91], the solution was flushed into the bloodstream.…”

Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

“…72,[83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] The remaining six studies included citrate or taurolidine. [100][101][102][103][104][105]123 Most studies were conducted in patients undergoing haemodialysis (n = 17), but there were four studies in children with cancer.…”

“…[100][101][102][103][104][105]123 Most studies were conducted in patients undergoing haemodialysis (n = 17), but there were four studies in children with cancer. [85][86][87]100 No studies compared locks in adults or children receiving parenteral nutrition.…”

“…On the other hand, the systematic review found relatively few studies in children with cancer (four studies). [85][86][87]100 None of the trials involved children undergoing care in a UK cancer centre. A large proportion of the trials of use of antimicrobial locks for prevention have involved renal patients:…”