title: A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children.
abstract: 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.
authors.affiliation: Division of Oncology, Children's Hospital of Philadelphia, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Rackoff
authors.forename: M
authors.initials: M
authors.lastname: Weiman
authors.forename: D
authors.initials: D
authors.lastname: Jakobowski
authors.forename: R
authors.initials: R
authors.lastname: Hirschl
authors.forename: V
authors.initials: V
authors.lastname: Stallings
authors.forename: J
authors.initials: J
authors.lastname: Bilodeau
authors.forename: P
authors.initials: P
authors.lastname: Danz
authors.forename: L
authors.initials: L
authors.lastname: Bell
authors.forename: B
authors.initials: B
authors.lastname: Lange
mesh_terms: 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*
chemical_list: D004338:Drug Combinations; D012996:Solutions; D014640:Vancomycin; D006493:Heparin