title: Fusidic acid and heparin lock solution for the prevention of catheter-related bloodstream infections in critically ill neonates: a retrospective study and a prospective, randomized trial.
abstract: OBJECTIVE
  Catheter-related bloodstream infections (CRBSIs) are one of the main morbidities in critically ill neonates. The objective of the present study was to assess the efficacy of a fusidic acid-heparin lock in the prevention of CRBSIs.
  
  
  METHODS
  A preliminary retrospective study showed that staphylococcal infections were largely prevalent. We planned a prospective, randomized trial to ascertain whether fusidic acid and heparin lock of central venous catheters would reduce the incidence of CRBSIs.
  
  
  METHODS
  Level III neonatal intensive care unit.
  
  
  METHODS
  One hundred three neonates were enrolled and randomly assigned to a treatment group (n = 50) or control group (n = 53).
  
  
  METHODS
  Fusidic acid (4 mg/mL) and heparin (10 IU/mL) lock in the treatment group.
  
  
  RESULTS
  The treatment group showed significantly lower incidence of CRBSIs (6.6 vs. 24.9 per 1000 catheter days; p < .01; relative risk 0.28; 95% confidence interval 0.13-0.60). No staphylococcal infections occurred in the treatment group, while in the control group Staphylococcus remained the main agent of CRBSI. Cost analysis comparing the present study and for the treatment of CRBSIs proved that antibiotic lock is financially favorable.
  
  
  CONCLUSIONS
  Fusidic acid-heparin lock solution reduced the incidence of CRBSIs in our neonatal intensive care unit. However, we recommend basing antibiotic lock on local CRBSI epidemiology. With regard to fusidic acid, further and broader studies could be useful to confirm our results.
authors.affiliation: Department of Critical Care Medicine, Meyer Children's Hospital, Florence, Italy. filippi.luca@virgilio.it
authors.forename: Luca
authors.initials: L
authors.lastname: Filippi
authors.forename: Marco
authors.initials: M
authors.lastname: Pezzati
authors.forename: Simona
authors.initials: S
authors.lastname: Di Amario
authors.forename: Chiara
authors.initials: C
authors.lastname: Poggi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pecile
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology*; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D005672:Fusidic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D005672:Fusidic Acid; D006493:Heparin