title: A simplified method of antibiotic lock therapy for Broviac-Hickman catheters using a CLC 2000 connector device.
abstract: BACKGROUND
  We report a simplified method of performing antibiotic lock therapy (ALT) based on a disposable central venous catheter (CVC) hub device, CLC 2000, enabling an open-ended CVC to be flushed with normal saline solution without heparin.
  
  
  METHODS
  ALT was administered through a CLC 2000 connector for recurrent CVC-bloodstream infections (BSI) by the same organism in four patients and for CVC colonization in five patients.
  
  
  RESULTS
  The antibiotic concentration obtained in the lumen of the CVC with ALT was 2,500-fold higher than the minimum inhibiting concentration of targeted bacteria for patients treated with vancomycin, 2,500-80,000-fold higher for patients treated with teicoplanin, and 10,000-fold higher for the patient treated with amikacin. All CVC-BSIs treated with ALT resulted in complete clinical and microbiological responses. No case of malfunction in withdrawing or flushing the CVC and no precipitation during the administration of the antibiotic solution was observed. No recurrence of CVC-BSI or CVC colonization by the same organism was diagnosed during subsequent follow-up, despite the fact that all patients had further periods of severe neutropenia. At the last follow-up, three CVCs had been removed for other infections (fever of unknown origin in two; fungemia in one), four CVCs had been removed at the end of therapy, and one CVC is still in situ 20 months after ALT.
  
  
  CONCLUSIONS
  In conclusion, a course of ALT is feasible in cancer patients with infected but much-needed CVCs before resorting to removal. The use of the CLC 2000 connector device simplifies the procedure for preparation and administration of ALT without compromising its efficacy.
authors.affiliation: Clinic of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy. simone.cesaro@unipd.it
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Mara
authors.initials: M
authors.lastname: Cavaliere
authors.forename: Monica
authors.initials: M
authors.lastname: Spiller
authors.forename: Lucia
authors.initials: L
authors.lastname: Rossi
authors.forename: Laura
authors.initials: L
authors.lastname: Magagna
authors.forename: Patrizia
authors.initials: P
authors.lastname: Gavin
authors.forename: Michela
authors.initials: M
authors.lastname: Bonetto
authors.forename: Modesto
authors.initials: M
authors.lastname: Carli
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003354:Corynebacterium Infections / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013212:Staphylococcus epidermidis; D017334:Teicoplanin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin; D000583:Amikacin