Meropenem-Heparin Lock Therapy for Ochrobactrum intermedium Catheter-Related Bloodstream Infection in a Pediatric Hemodialysis Patient: A Case Report and Literature Review.

BACKGROUND: In pediatric hemodialysis patients with exhausted vascular access, managing rare pathogens like Ochrobactrum intermedium is challenging, often posing a dilemma between catheter removal and salvage attempts. There are few reports on the supported viability of meropenem-heparin lock therapy for this purpose in pediatric patients.

CASE PRESENTATION: We present the case of a 12-year-old male with chronic kidney disease on hemodialysis who was admitted with sepsis attributed to her long-term hemodialysis catheter. Ochrobactrum intermedium was isolated from all catheter lumens and blood cultures. Due to a documented history of vascular access failure, catheter salvage was the primary goal. A combined systemic antibiotic and lock therapy with meropenem and unfractionated heparin was initiated. Critically, bacteremia relapsed promptly after a planned temporary suspension of the lock therapy, while systemic antibiotics were continued. Definitive microbiological eradication was only achieved after the re-initiation and completion of a 14-day course of the lock therapy, resulting in full clinical recovery and long-term catheter preservation. This case report suggests the potential efficacy of meropenem lock therapy as a salvage strategy for O. intermedium CRBSI when catheter removal is not a viable option. The relapse upon its suspension highlights that the lock therapy itself was the critical component for eradicating the O. intermedium biofilm, a feat the systemic antibiotic alone could not achieve. This approach is a viable alternative when catheter removal is not feasible.