Efficacy of antibiotic-lock technique with teicoplanin in staphylococcus epidermidis catheter-related sepsis during long-term parenteral nutrition.
BACKGROUND
The antibiotic-lock technique has been suggested to treat catheter-related sepsis in parenteral nutrition and to avoid catheter removal.


METHODS
To determine the incidence of catheter-related sepsis, the bacteria involved, and the efficacy of the antibiotic-lock technique with teicoplanin, all patients (n = 263) undergoing parenteral nutrition from January 1997 to December 1999 in one center, with patients at the hospital (n = 209) and at home (54) were retrospectively studied. The antibiotic-lock technique with teicoplanin was systematically used in all suspected infections and maintained in staphylococcus epidermidis (SE) infections.


RESULTS
A total of 21 of 263 patients had 34 infections (0.11/patient per year): 12 of 209 hospitalized and 9 of 54 home patients. A total of 10 of 34 infections were due to non-SE, and the catheter was immediately removed. The other 24 of 34 infections were due to SE; in 5 of 24, the catheter was removed after 48 hours of the antibiotic-lock technique because of persistent fever or thrombosis. A total of 5 of 12 patients had 2 or more infections on the same catheter. The antibiotic-lock technique prevented short-term catheter removal in these cases, but a second infection occurred within a median of 50 days. In 4 of 5 cases, a third infection occurred in a mean delay of 90 days so that the catheter was removed. In 3 of 5 patients, bacteria was analyzed with pulsed field gel electrophoresis, which showed that recurrent infections were due to the same strain in all cases.


CONCLUSIONS
In this study, the incidence of catheter-related sepsis was low and mostly related to SE. Our results do not support the use of the teicoplanin antibiotic-lock technique in SE infections.
Guedon
C
C
Hépato-Gastroenterology and Nutrition Unit, Hospital Charles Nicolle, Rouen, France. claire.guedon@chu-rouen.fr
Nouvellon
M
M
Lalaude
O
O
Lerebours
E
E
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D006701:Home Nursing; D006760:Hospitalization; D006801:Humans; D010288:Parenteral Nutrition; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D013212:Staphylococcus epidermidis; D017334:Teicoplanin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D017334:Teicoplanin