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Antimicrobial Agents and Chemotherapy, March 2006, p. 1120-1121, Vol. 50, No. 3
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.3.1120-1121.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Catheter Lock and Systemic Infusion of Linezolid for Treatment of Persistent Broviac Catheter-Related Staphylococcal Bacteremia


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The treatment of persistently positive blood cultures in the setting of indwelling central venous catheter (CVC)-related bacteremia may represent a difficult task when CVC removal is not feasible. In this setting, antibiotic lock has been demonstrated to be an effective option, both as a first-line and as a rescue treatment (3, 5), but CVC removal probably remains the treatment of choice. However, this procedure may not always be possible in patients in life-threatening clinical condition or with limited vascular sites, like infants, especially if requiring life-long total parenteral nutrition, or in the presence of conditions that makes catheter withdrawal impossible or at least very difficult.

We used linezolid as systemic and lock therapy for the treatment of CVC-related Staphylococcus epidermidis bloodstream infection not responding to other treatments and with clinical conditions that precluded catheter removal.

The patient, a 4-year-old girl affected with cystic fibrosis and short-bowel syndrome requiring a Broviac catheter for daily parenteral nutrition, had CVC-related bacteremia due to oxacillin-resistant S. epidermidis diagnosed in the presence of fever and positive blood cultures derived from the CVC, but not from a peripheral vein (3). Table 1 details the susceptibility pattern of the isolated strain. Vancomycin at 40 mg/kg/day was started, but after the second dose the patient developed a severe skin rash, and therefore treatment was changed to teicoplanin at 10 mg/kg/dose. After 6 days of this therapy, blood cultures were still positive and therefore antibiotic lock with vancomycin at 5 mg/ml for 12 h/day was added to the systemic therapy (3). In spite of this new treatment, blood cultures remained positive. Catheter removal was not feasible, unless to perform an extremely invasive cardiovascular surgical procedure, since the patient had an extended thrombosis of the veins that involved the catheter and locked the device to the blood vessels. No signs of cardiac vegetation were present. Linezolid at a concentration of 2 mg/ml plus 100 U of heparin (1) was employed as an 8-h catheter lock, in association with systemic infusion of 10 mg/kg/8 h (4, 6). The idea of this therapeutic procedure stemmed from the observation that very high concentrations of linezolid, achievable by means of catheter lock, were effective in two experimental models of CVC-related staphylococcal infections (1, 2). The lock time was shorter than that reported in these studies, since the patient needed daily parenteral nutrition that could not be administered for less than 12 h. Blood cultures were negative after the second day of treatment. Linezolid lock associated with systemic infusion was continued for a total of 20 days without any adverse event. Blood cultures performed daily during this period remained always negative. Three weeks after the end of treatment, blood cultures were still negative and the patient was alive and had the CVC still in place.


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  		TABLE 1. Susceptibility pattern of S. epidermidis causing Broviac catheter-related infections not responding to glycopeptides administered systemically and by antibiotic lock

 
Catheter removal represents the treatment of choice for persistent CVC-related bacteremia (3). However, in the presence of clinical conditions that contraindicate this procedure, CVC lock with linezolid may represent a possible treatment option for gram-positive infections when other, more standardized, therapies have failed.


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  1. Curtin, J., M. Cormican, G. Fleming, J. Keelehan, and E. Colleran. 2003. Linezolid compared with eperezolid, vancomycin, and gentamicin in an in vitro model of antimicrobial lock therapy for Staphylococcus epidermidis central venous catheter-related biofilm infections. Antimicrob. Agents Chemother. 47:3145-3148.[Abstract/Free Full Text]
  2. Giacometti, A., O. Cirioni, R. Ghiselli, F. Orlando, F. Mocchegiani, C. Silvestri, A. Licci, M. De Fusco, M. Provinciali, V. Saba, and G. Scalise. 2005. Comparative efficacies of quinupristin-dalfopristin, linezolid, vancomycin, and ciprofloxacin in treatment, using the antibiotic-lock technique, of experimental catheter-related infection due to Staphylococcus aureus. Antimicrob. Agents Chemother. 49:4042-4045.[Abstract/Free Full Text]
  3. Mermel, L. A., B. M. Farr, R. J. Sheretz, I. I. Raad, N. O'Grady, J. S. Harris, and D. E. Craven. 2001. Guidelines for the management of intravascular catheter-related infections. Clin. Infect. Dis. 32:1249-1272.[CrossRef][Medline]
  4. Michelow, I. C., and G. H. McCracken, Jr. 2004. Antibacterial therapeutic agents, p. 2987-3029. In R. D. Feigin, J. D. Cherry, G. J. Demmler, and S. L. Kaplan, (ed.), Textbook of pediatric infectious diseases. The W. B. Saunders Co., Philadelphia, Pa.
  5. Rijnders, B. J., E. Van Wijngaerden, S. J. Vandecasteele, M. Stas, and W. E. Peetermans. 2005. Treatment of long-term intravascular catheter-related bacteremia with antibiotic lock: randomized, placebo-controlled trial. J. Antimicrob. Chemother. 55:90-94.[Abstract/Free Full Text]
  6. Stalker, D. J., and G. L. Jungbluth. 2003. Clinical pharmacokinetics of linezolid, a novel oxazolidinone antibacterial. Clin. Pharmacokinet. 42:1129-1140.[CrossRef][Medline]
Elio Castagnola*
Cristina Moroni
Infectious Diseases Unit
Department of Hematology and Oncology,1

Paolo Gandullia
Gastroenterology Unit,2

Mauro Oddone
Service of Radiology,3

Cristiano Peri
Laboratory of Microbiology,4

Rosaria Casciaro
Alessandra De Alessandri
Center for the Treatment of Cystic Fibrosis of the University of Genoa G. Gaslini Children's Hospital Largo G. Gaslini, 5 Genoa 16147, Italy,5

* Phone: 39-010-5636428, Fax: 39-010384323, E-mail: eliocastagnola{at}ospedale-gaslini.ge.it

Antimicrobial Agents and Chemotherapy, March 2006, p. 1120-1121, Vol. 50, No. 3
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.3.1120-1121.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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