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.
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.
Filippi
Luca
L
Department of Critical Care Medicine, Meyer Children's Hospital, Florence, Italy. filippi.luca@virgilio.it
Pezzati
Marco
M
Di Amario
Simona
S
Poggi
Chiara
C
Pecile
Patrizia
P
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
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D005672:Fusidic Acid; D006493:Heparin