Randomized controlled, double blind trial of use of vancomycin catheter-lock to prevent Gram-positive bloodstream infection in neonates.

BACKGROUND

Central lines are more frequently used in infant newborns; they offer advantages but are related to traumatic complications, obstruction and infection. Antibiotics in catheter locks may decrease infections. The aim of this work was to evaluate the efficacy of vancomycin catheter lock to prevent Gram-positive bloodstream infection.

METHODS

Randomized controlled doubled blind trial in newborn with central catheter in first 48 hours. Parents informed consent was obtained. Two groups were formed: experimental group with vancomycin catheter lock twice a day for 30 minutes and control group with normal saline solution catheter lock. Primary outcome was Gram-positive bacterial bloodstream infection. Trial was approved by the project review committees of the National Institute of Pediatrics.

RESULTS

Sixty-one patients were included, with mean gestational age of 34.9 weeks of gestation and 2,044 g of weight. Mean stay of catheter was 14.6 days and parenteral nutrition 12 days. It was lower suspicion of sepsis in experimental group (25 vs. 34.5%), fewer bloodstream infections (3.1 vs. 13.8%) and lower infection density per 1,000 catheter/days (2.3 vs. 4.6), but none of these were statistically significative.

CONCLUSIONS

Vancomycin catheter-lock diminished bloodstream infections at 25% respect control group and 50% density infection per 1000 catheter/days, without being statistically significant.