Randomized, Double-Blind Trial of an Antibiotic-Lock Technique for Prevention of Gram-Positive Central Venous Catheter-Related Infection in Neutropenic Patients with Cancer
- 1 September 1999
- journal article
- clinical trial
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 43 (9) , 2200-2204
- https://doi.org/10.1128/aac.43.9.2200
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.Keywords
This publication has 36 references indexed in Scilit:
- Central venous catheter-related sepsis in a cohort of 366 hospitalised patientsEuropean Journal of Clinical Microbiology & Infectious Diseases, 1997
- Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institutionEuropean Journal of Clinical Microbiology & Infectious Diseases, 1996
- The Broad-Spectrum Activity and Efficacy of Catheters Coated with Minocycline and RifampinThe Journal of Infectious Diseases, 1996
- Molecular Tracking of Coagulase-Negative Staphylococcal Isolates From Catheter-Related InfectionsMicrobial Drug Resistance, 1996
- A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in childrenThe Journal of Pediatrics, 1995
- Infectious Complications of Indwelling Vascular CathetersClinical Infectious Diseases, 1992
- Antibiotic-lock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutritionClinical Nutrition, 1990
- Bacteraemia related to indwelling central venous catheters: Prevention, diagnosis and treatmentEuropean Journal of Clinical Microbiology & Infectious Diseases, 1988
- A Dilute Solution of Vancomycin and Heparin Retains Antibacterial and Anticoagulant ActivitiesThe Journal of Infectious Diseases, 1988
- A Semiquantitative Culture Method for Identifying Intravenous-Catheter-Related InfectionNew England Journal of Medicine, 1977