Subscribe to RSS
The Role of a Single Dose of Vancomycin in Reducing Clinical Sepsis in Premature Infants Prior to Removal of Peripherally Inserted Central Catheter: A Retrospective StudyFunding None.
30 June 2017
12 January 2018
23 February 2018 (online)
Objective Peripherally inserted central catheter (PICC) line removal is associated with bloodstream infections and clinical sepsis. We aim to investigate the role of a single prophylactic dose of vancomycin in decreasing the incidence of central line associated bloodstream infection associated with PICC removal.
Methods A retrospective chart review of patients in the neonatal intensive care unit was conducted. Patients were divided into two study groups based on whether a single dose of vancomycin was administered (exposed) or not (nonexposed). The primary outcome measured was clinical sepsis with or without positive blood culture.
Results The incidence of clinical sepsis in the exposed group was 7.3% compared with 6.3% in the nonexposed group (p-value: 0.7860). The incidence of culture-positive sepsis in the exposed group was 2.2% compared with 1.6% in the nonexposed group (p-value: 0.7673). The overall incidence of clinical and culture-positive sepsis in the subgroup with infants weighing <1,500 g and <32 weeks' gestational age was similar to the main study group.
Conclusion Our data do not support routine vancomycin prophylaxis prior to PICC line removal in premature infants to prevent sepsis associated with PICC removal. However, a large randomized controlled trial is further needed to delineate these results.
- 1 Perin G. PICC placement in the neonate. N Engl J Med 2014; 370 (22) 2153-2154
- 2 van den Hoogen A, Brouwer MJ, Gerards LJ, Fleer A, Krediet TG. Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis. Acta Paediatr 2008; 97 (09) 1250-1252
- 3 O'Grady NP, Alexander M, Burns LA. , et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39 (04) (Suppl. 01) S1-S34
- 4 Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004; 30 (01) 62-67
- 5 Garland JS, Uhing MR. Strategies to prevent bacterial and fungal infection in the neonatal intensive care unit. Clin Perinatol 2009; 36 (01) 1-13
- 6 Brooker RW, Keenan WJ. Catheter related bloodstream infection following PICC removal in preterm infants. J Perinatol 2007; 27 (03) 171-174
- 7 Hemels MA, van den Hoogen A, Verboon-Maciolek MA, Fleer A, Krediet TG. Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants. Pediatr Crit Care Med 2011; 12 (04) 445-448
- 8 Reynolds GE, Tierney SB, Klein JM. Antibiotics before removal of percutaneously inserted central venous catheters reduces clinical sepsis in premature infants. J Pediatr Pharmacol Ther 2015; 20 (03) 203-209
- 9 Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006; 166 (19) 2138-2144
- 10 Healy CM, Palazzi DL, Edwards MS, Campbell JR, Baker CJ. Features of invasive staphylococcal disease in neonates. Pediatrics 2004; 114 (04) 953-961
- 11 Casner M, Hoesli SJ, Slaughter JC, Hill M, Weitkamp JH. Incidence of catheter-related bloodstream infections in neonates following removal of peripherally inserted central venous catheters. Pediatr Crit Care Med 2014; 15 (01) 42-48
- 12 Garland JS, Alex CP, Henrickson KJ, McAuliffe TL, Maki DG. A vancomycin-heparin lock solution for prevention of nosocomial bloodstream infection in critically ill neonates with peripherally inserted central venous catheters: a prospective, randomized trial. Pediatrics 2005; 116 (02) e198-e205
- 13 Harms K, Herting E, Kron M, Schiffmann H, Schulz-Ehlbeck H. Randomized, controlled trial of amoxicillin prophylaxis for prevention of catheter-related infections in newborn infants with central venous silicone elastomer catheters. J Pediatr 1995; 127 (04) 615-619
- 14 Spafford PS, Sinkin RA, Cox C, Reubens L, Powell KR. Prevention of central venous catheter-related coagulase-negative staphylococcal sepsis in neonates. J Pediatr 1994; 125 (02) 259-263
- 15 Storey S, Brown J, Foley A. , et al. A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial. Am J Infect Control 2016; 44 (06) 636-641