A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children.
OBJECTIVE
To determine whether adding vancomycin to central venous catheter (CVC) flush solution would significantly reduce the incidence of bacteremia attributable to luminal colonization with vancomycin-susceptible organisms.


METHODS
Fifty-five children with cancer and eight children given total parenteral nutrition by the surgery or nutrition support services were randomly assigned to receive a heparin CVC flush solution (n = 31) or a heparin-vancomycin CVC flush solution (n = 32).


RESULTS
During 9158 catheter days, 6.5% of the patients in the heparin group and 15.6% of the patients in the heparin-vancomycin group had bacteremia attributable to luminal colonization with vancomycin-susceptible organisms (p = 0.43). The mean rates of bacteremia attributable to luminal colonization with vancomycin-susceptible organisms were 0.6/1000 catheter days in the heparin group and 1.4/1000 catheter days in the heparin-vancomycin group (p = 0.25). There was no significant difference between the groups when the time to the first episode of bacteremia attributable to luminal colonization with a vancomycin-susceptible organism was compared by means of Kaplan-Meier survival estimates. Streptococcus viridans infection was not attributable to luminal colonization.


CONCLUSIONS
The addition of vancomycin to heparin CVC flush solution did not reduce bacteremia with vancomycin-susceptible organisms. Bacteremia with Streptococcus viridans was not related to the use of a CVC.
Rackoff
W R
WR
Division of Oncology, Children's Hospital of Philadelphia, USA.
Weiman
M
M
Jakobowski
D
D
Hirschl
R
R
Stallings
V
V
Bilodeau
J
J
Danz
P
P
Bell
L
L
Lange
B
B
D000293:Adolescent; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D016983:Enterococcus / Q000302:isolation & purification / Q000472:pathogenicity; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010288:Parenteral Nutrition; D012996:Solutions; D013291:Streptococcus / Q000302:isolation & purification / Q000472:pathogenicity; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
D004338:Drug Combinations; D012996:Solutions; D014640:Vancomycin; D006493:Heparin