Conventional and Nonconventional Modes of Vancomycin Administration to Decontaminate the Internal Surface of Catheters Colonized with Coagulase‐Negative Staphylococci

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Abstract
Using a quantitative in vitro model simulating clinical conditions, we studied the efficacy of conventional and nonconventional 3‐day therapies involving vancomycin for treating the internal surface of catheters colonized with a slime‐producing strain of Staphylococcus epidermidis. When infused for 1 hr every 8 hr through the catheter at the daily dose recommended for a 10‐kg child (450 mg), vancomycin alone reduced bacterial colonization but failed to sterilize the inserts. Vancomycin was more active in combination with netilmicin (25 mg for 1 hr every 8 hr), rifampin (150 mg for 90 min every 12 hr), or fosfomycin (500 mg for 4 hr every 6 hr), but the catheters were inconsistently decontaminated after 3 days of treatment. Two nonconventional modes of antibiotic administration were tested for their capacity to ensure high levels of vancomycin in the catheter lumen over a prolonged time. Vancomycin infused continuously through the catheter at a daily dose of 450 mg had the same poor sterilizing effect as vancomycin administered intermittently. On the contrary, catheters were totally decontaminated when 2.5 mg of vancomycin in a volume of 0.5 ml were injected twice daily into noninfused catheters, confirming that the antibiotic‐lock technique is an approach of great interest to sterilize the internal surface of catheters colonized with staphylococci.(Journal of Parenteral and Enteral Nutrition 14:593–597, 1990)