Evaluating the Incidence of Sepsis Post–Central Catheter Removal When Using Prophylactic Vancomycin in the Neonatal Intensive Care Unit

Abstract

OBJECTIVE With no consensus, the practice of using prophylactic antibiotics prior to central venous catheter (CVC) removal in NICU patients remains controversial. The objective of this study was to compare the incidence of sepsis post–CVC removal in those who received a dose of vancomycin prophylactically with those who did not. METHODS This single-center, retrospective chart review included NICU patients who had CVCs removed. Patients were excluded if they had a confirmed or suspected infection at the time of CVC removal or if the indwelling CVC was removed prior to 30 days from insertion. Primary outcome was the occurrence of a sepsis evaluation within 72 hours from CVC removal. Secondary outcomes included the development of acute kidney injury, source and identification of positive cultures, time to onset of suspected or confirmed sepsis, and the appropriate administration of intravenous vancomycin. RESULTS Eighty-two CVC removals received prophylactic vancomycin (P-VAN), and 22 CVCs did not receive prophylactic vancomycin (NP-VAN) prior to CVC removal. There were no significant differences in patient demographics between groups and median duration of indwelling CVC. Two clinical sepsis evaluations occurred in the P-VAN group compared with none in the NP-VAN group. Of all the P-VAN CVC removals, 45 (55%) received vancomycin appropriately. There were no statistical differences in all evaluated secondary outcomes. CONCLUSIONS Vancomycin administered prophylactically prior to CVC removal did not reduce the number of subsequent clinical sepsis evaluations or infections in NICU patients.

Antibiotic use at planned central line removal in reducing neonatal post-catheter removal sepsis: a systematic review and meta-analysis

“…Among the remaining 10 studies, four studies regarding routine prophylactic or therapeutic antibiotics use ( 2 , 19 – 21 ) and one non-comparative study ( 22 ) were excluded. Therefore, a total of five studies, including one RCT ( 23 ) and four retrospective studies ( 1 , 24 – 26 ) were ultimately enrolled in the quantitative analyses ( Table 1 ).…”

“…Risk of bias of retrospective studies were assessed by a modified NOS ( Supplementary Table S2 ). The total score of the four studies ( 1 , 24 – 26 ) was 7, 8, 9, 7, respectively, indicating a moderate to low risk of bias. The risk of bias of the RCT ( 23 ) was assessed by using the Cochrane risk-of-bias tool, which was detailed in the Supplementary Table S1 .…”

“…Central venous catheters (CVCs) are commonly used in the neonatal intensive care unit (NICU), contributing to better survival outcomes in critically ill newborn infants. Post-catheter removal sepsis (PCRS) is an important complication of indwelling CVCs with an incidence reported varying from 1.9% to 11.6% ( 1 , 2 ). PCRS is predominantly caused by late-onset central line-associated blood stream infection (CLABSI) which is defined as a primary blood stream infection developing within 48 h after CVCs removal in the absence of other known infection sites ( 3 ).…”

Antibiotic Use at Planned Central Line Removal in Reducing Neonatal Post-Catheter Removal Sepsis: A Systematic Review and Meta-analysis

“…Risk of bias of retrospective studies were assessed by a modi ed NOS (Supplementary table 2). The total score of the four studies [22][23][24][25] was 7, 8, 9, 7, respectively, indicating a moderate to low risk of bias. The risk of bias of the RCT 21 was assessed by using the Cochrane risk-of-bias tool, which was detailed in supplementary Material 3.…”

“…Among the remaining 10 studies, four studies regarding routine prophylactic or therapeutic antibiotics use [16][17][18][19] and one non-comparative study 20 were excluded. Therefore, a total of ve studies, including one RCT 21 and four retrospective studies [22][23][24][25] were ultimately enrolled in the quantitative analyses (Table 1).…”