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Antimicrobial Agents and Chemotherapy, September 1999, p. 2200-2204, Vol. 43, No. 9
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Randomized, Double-Blind Trial of an Antibiotic-Lock Technique for Prevention of Gram-Positive Central Venous Catheter-Related Infection in Neutropenic Patients with Cancer

Jordi Carratalà,1,* Jordi Niubó,2 Alberto Fernández-Sevilla,3 Eulalia Juvé,3 Xavier Castellsagué,4 Juan Berlanga,3 Josefina Liñares,2 and Francesc Gudiol1

Infectious Disease Service,1 Microbiology Service,2 Clinical Hematology Service,3 and Cancer Epidemiology Service,4 Ciutat Sanitària i Universitària de Bellvitge, Institut Català d'Oncologia, University of Barcelona, Barcelona, Spain

Received 2 December 1998/Returned for modification 17 May 1999/Accepted 11 June 1999

The aim of the present study was to determine the efficacy of an antibiotic-lock technique in preventing endoluminal catheter-related infection with gram-positive bacteria in neutropenic patients with hematologic malignancies. Patients with nontunneled, multilumen central venous catheters were assigned in a randomized, double-blinded manner to receive either 10 U of heparin per ml (57 patients) or 10 U of heparin per ml and 25 µg of vancomycin per ml (60 patients), which were instilled in the catheter lumen and which were allowed to dwell in the catheter lumen for 1 h every 2 days. Insertion-site and hub swabs were taken twice weekly. The primary and secondary end points of the trial were significant colonization of the catheter hub and catheter-related bacteremia, respectively. Significant colonization of the catheter hub occurred in nine (15.8%) patients receiving heparin (seven patients were colonized with Staphylococcus epidermidis, one patient was colonized with Staphylococcus capitis, and one patient was colonized with Corynebacterium sp.), whereas the catheter hubs of none of the patients receiving heparin and vancomycin were colonized (P = 0.001). Catheter-related bacteremia developed in four (7%) patients receiving heparin (three patients had S. epidermidis bacteremia and one patient had S. capitis bacteremia), whereas none of the patients in the heparin and vancomycin group had catheter-related bacteremia (P = 0.05). The times to catheter hub colonization and to catheter-related bacteremia by the Kaplan-Meier method were longer in patients receiving heparin and vancomycin than in patients receiving heparin alone (P = 0.004 and P = 0.06, respectively). Our study shows that a solution containing heparin and vancomycin administered by using an antibiotic-lock technique effectively prevents catheter hub colonization with gram-positive bacteria and subsequent bacteremia during chemotherapy-induced neutropenia in patients with hematologic malignancy.

* Corresponding author. Mailing address: Infectious Disease Service, Hospital de Bellvitge, Feixa Llarga sn, 08907 L'Hospitalet, Barcelona, Spain. Phone: 34933357011, ext. 2487. Fax: 34932607637. E-mail: jcarratala{at}csub.scs.es.

Antimicrobial Agents and Chemotherapy, September 1999, p. 2200-2204, Vol. 43, No. 9
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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