Randomized, Double-Blind Trial of an Antibiotic-Lock Technique for Prevention of Gram-Positive Central Venous Catheter-Related Infection in Neutropenic Patients with Cancer

Abstract

The aim of the present study was to determine the efficacy of an antibiotic-lock technique in preventing endoluminal catheter-related infection with gram-positive bacteria in neutropenic patients with hematologic malignancies. Patients with nontunneled, multilumen central venous catheters were assigned in a randomized, double-blinded manner to receive either 10 U of heparin per ml (57 patients) or 10 U of heparin per ml and 25 μg of vancomycin per ml (60 patients), which were instilled in the catheter lumen and which were allowed to dwell in the catheter lumen for 1 h every 2 days. Insertion-site and hub swabs were taken twice weekly. The primary and secondary end points of the trial were significant colonization of the catheter hub and catheter-related bacteremia, respectively. Significant colonization of the catheter hub occurred in nine (15.8%) patients receiving heparin (seven patients were colonized with Staphylococcus epidermidis, one patient was colonized with Staphylococcus capitis, and one patient was colonized withCorynebacterium sp.), whereas the catheter hubs of none of the patients receiving heparin and vancomycin were colonized (P = 0.001). Catheter-related bacteremia developed in four (7%) patients receiving heparin (three patients had S. epidermidis bacteremia and one patient had S. capitisbacteremia), whereas none of the patients in the heparin and vancomycin group had catheter-related bacteremia (P = 0.05). The times to catheter hub colonization and to catheter-related bacteremia by the Kaplan-Meier method were longer in patients receiving heparin and vancomycin than in patients receiving heparin alone (P = 0.004 and P = 0.06, respectively). Our study shows that a solution containing heparin and vancomycin administered by using an antibiotic-lock technique effectively prevents catheter hub colonization with gram-positive bacteria and subsequent bacteremia during chemotherapy-induced neutropenia in patients with hematologic malignancy.

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.…”

Minocycline‐Ethylenediaminetetraacetate Lock Solution for the Prevention of Implantable Port Infections in Children with Cancer

“…Because staphylococci are the most common cause of CRBSI, the combination of vancomycin and heparin has often been used as a flush solution [4][5][6][7][8]. Four prospective randomized studies [4][5][6]8] have demonstrated the benefit of heparinvancomycin lock solution in preventing CRBSI caused by vancomycin-susceptible microorganisms. A smaller prospective randomized, controlled trial in children failed to show any benefit of the vancomycin-heparin lock solution over heparin alone in preventing CRBSI [7].…”

Incidence and risk factors for central venous access port-related infection in Chinese cancer patients

“…The incidence rate of central port-related infections (CPI) has been reported to vary from 7% to 19%. 3,4 Many risk factors for CPI have been reported, including hematological malignancy, neutropenia, chronic steroid use, lacking perioperative antibiotic use, pancreatic cancer, poor performance status, previous infection, parenteral nutrition, immediate palliative care after implantation, and an inexperienced surgeon. 5e8 Considering the evolution of new materials in the make-up of central port devices, and prolonged cancer survival resulting in longer period of chemotherapy, it is possible that the incidence of CPI and associated risk factors have changed.…”