title: Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulase-negative staphylococci.
abstract: Using a quantitative in vitro model simulating clinical conditions, we studied the efficacy of conventional and nonconventional 3-day therapies involving vancomycin for treating the internal surface of catheters colonized with a slime-producing strain of Staphylococcus epidermidis. When infused for 1 hr every 8 hr through the catheter at the daily dose recommended for a 10-kg child (450 mg), vancomycin alone reduced bacterial colonization but failed to sterilize the inserts. Vancomycin was more active in combination with netilmicin (25 mg for 1 hr every 8 hr), rifampin (150 mg for 90 min every 12 hr), or fosfomycin (500 mg for 4 hr every 6 hr), but the catheters were inconsistently decontaminated after 3 days of treatment. Two nonconventional modes of antibiotic administration were tested for their capacity to ensure high levels of vancomycin in the catheter lumen over a prolonged time. Vancomycin infused continuously through the catheter at a daily dose of 450 mg had the same poor sterilizing effect as vancomycin administered intermittently. On the contrary, catheters were totally decontaminated when 2.5 mg of vancomycin in a volume of 0.5 ml were injected twice daily into noninfused catheters, confirming that the antibiotic-lock technique is an approach of great interest to sterilize the internal surface of catheters colonized with staphylococci.
authors: Laboratoire Central de Microbiologie, Hôpital Necker-Enfants Malades, Paris, France.
authors: J L
authors: JL
authors: Gaillard
authors: R
authors: R
authors: Merlino
authors: N
authors: N
authors: Pajot
authors: O
authors: O
authors: Goulet
authors: J L
authors: JL
authors: Fauchere
authors: C
authors: C
authors: Ricour
authors: M
authors: M
authors: Veron
mesh_terms: D002408:Catheters, Indwelling; D004357:Drug Synergism; D004866:Equipment Contamination; D005578:Fosfomycin / Q000494:pharmacology; D006801:Humans; D066298:In Vitro Techniques; D009428:Netilmicin / Q000494:pharmacology; D012293:Rifampin / Q000494:pharmacology; D013212:Staphylococcus epidermidis / Q000187:drug effects*; D014640:Vancomycin / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D005578:Fosfomycin; D009428:Netilmicin; D014640:Vancomycin; D012293:Rifampin