Vancomycin vs teicoplanin antibiotic lock therapy for pediatric coagulase negative staphylococcal central line associated bloodstream infections

Year 2025, Volume: 8 Issue: 5, 914 - 918, 16.09.2025

Zeynep Ergenç , Aylin Dizi Işık , Sevgi Aslan Tuncay , Seyhan Yılmaz , Pınar Canizci Erdemli , Eda Kepenekli

https://doi.org/10.32322/jhsm.1762968

Abstract

Aims: Central line associated bloodstream infections (CLABSIs) are the major complication of central lines. Coagulase-negative Staphylococcus (CoNS) are the leading cause of CLABSI often necessitating line removal. While antibiotic lock therapy (ALT) is widely utilized in adults, pediatric specific data remains limited. In this study we aimed to evaluate the ALT outcomes in children with CoNS CLABSIs.
Methods: Children with CoNS CLABSIs who received ≥72 hours of ALT with either vancomycin or teicoplanin between January 2020-2023 were retrospectively reviewed. Data on demographic and clinical characteristics, management strategies, and outcomes were analyzed. ALT success was defined as clinical resolution, negative follow-up blood cultures, and catheter retention.
Results: Nineteen patients were included (median age 50 months; 58% female). Methicillin-sensitive CoNS (MSCoNS) were isolated in 4 (21%) cases and methicillin-resistant CoNS (MRCoNS) in 15 (79%). ALT regimens comprised vancomycin (n=9, 47%), teicoplanin (n=8, 42%), or sequential use (n=2, 11%). Overall, ALT success was 63% (12/19). Vancomycin-based ALT succeeded in 56% (5/9) vs. 62.5% (5/8) for teicoplanin (p=1.0). Success was higher in MSCoNS CLABSIs (100%) than MRCoNS (53%), though not statistically significant (p=0.245). Younger age (p=0.003) and persistent positive cultures (p=0.013) were associated with catheter loss. No infection-related mortality occurred. Recurrence occurred in 3 (16%) patients and reinfection in 5 (26%).
Conclusion: ALT achieved satisfactory catheter salvage rates in pediatric CoNS CLABSI, with comparable efficacy between vancomycin and teicoplanin. Younger age and persistent bacteremia predicted failure. Vancomycin or teicoplanin based ALT can be used in selected children with CoNS CLABSI.

Keywords

Catheter-related infections , coagulase , Staphylococcus , teicoplanin , vancomycin

Ethical Statement

The study was approved by the Local Ethics Committee (reference number 09.2023.621).

Pediatrik koagülaz negatif stafilokok santral kateter ilişkili kan dolaşımı enfeksiyonlarında vankomisin ve teikoplanin antibiyotik kilit tedavisinin karşılaştırılması

Abstract

Amaç: Santral kateter ilişkili kan dolaşımı enfeksiyonları (SKİKDE), santral kateterlerin en önemli komplikasyonlarından biridir. Koagülaz-negatif stafilokoklar (KNS), çoğu zaman kateterin çıkarılmasını gerektiren SKİKDE’nin başlıca nedenidir. Antibiyotik kilit tedavisi (AKT) erişkinlerde yaygın olarak kullanılmasına rağmen, çocuklara özgü veri sınırlıdır. Bu çalışmada, KNS kaynaklı SKİKDE’li çocuklarda AKT sonuçlarını değerlendirmeyi amaçladık.
Yöntemler: Ocak 2020–2023 tarihleri arasında, KNS kaynaklı SKİKDE tanısıyla ≥72 saat süreyle vankomisin veya teikoplanin ile AKT uygulanan çocuk hastalar retrospektif olarak incelendi. Demografik ve klinik özellikler, tedavi yaklaşımları ve sonuçlara ilişkin veriler analiz edildi. AKT başarısı; klinik düzelme, takip kan kültürlerinde üremenin saptanmaması ve kateterin korunması olarak tanımlandı.
Bulgular: Toplam 19 hasta çalışmaya dahil edildi (ortanca yaş 50 ay; %58’i kız). Metisiline duyarlı KNS (MDKNS) 4 (%21) vakada, metisiline dirençli KNS (MDKNS) ise 15 (%79) vakada izole edildi. AKT rejimleri vankomisin (n=9, %47), teikoplanin (n=8, %42) veya ardışık kullanım (n=2, %11) şeklindeydi. Genel AKT başarısı %63 (12/19) idi. Vankomisin bazlı AKT %56 (5/9) oranında, teikoplanin bazlı AKT ise %62,5 (5/8) oranında başarılı oldu (p=1,0). Başarı, MDKNS SKİKDE vakalarında (%100) MRKNS vakalarına (%53) göre daha yüksek olmakla birlikte istatistiksel olarak anlamlı değildi (p=0,245). Daha küçük yaş (p=0,003) ve persistan pozitif kültür varlığı (p=0,013) kateter kaybı ile ilişkili bulundu. İki hastada endokardit gelişti; enfeksiyon ilişkili mortalite görülmedi. Üç (%16) hastada nüks, beş (%26) hastada yeniden enfeksiyon saptandı.
Sonuç: AKT, pediatrik KNS kaynaklı SKİKDE olgularında tatmin edici kateter koruma oranları sağlamış ve vankomisin ile teikoplanin arasında etkinlik açısından fark gözlenmemiştir. Daha küçük yaş ve persistan bakteriyemi, tedavi başarısızlığını öngören faktörlerdir. Daha geniş hasta serileri ile yapılacak prospektif çalışmalara ihtiyaç vardır.

Keywords

kateter ilişkili enfeksiyon , koagülaz , stafilokoklar , teikoplanin , vankomisin

References

• Hsu HE, Mathew R, Wang R, et al. Health care-associated infections among critically ill children in the US, 2013-2018. JAMA Pediatr. 2020; 174(12):1176-1183. doi:10.1001/jamapediatrics.2020.3223
• Kopsidas I, Collins M, Zaoutis T. Healthcare-associated infections-can we do better? Pediatr Infect Dis J. 2021;40(8):e305-e309. doi:10.1097/INF.0000000000003203
• Fratino G, Molinari AC, Parodi S, et al. Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol. 2005;16(4):648-654. doi: 10.1093/annonc/mdi111
• Walker LW, Visweswaran S, Nowalk AJ. Outcomes in pediatric central line-associated bloodstream infections treated with antimicrobial locks: a 14-year retrospective analysis. Pediatr Infect Dis J. 2023;42(6):473-478. doi:10.1097/INF.0000000000003885
• Rabelo BS, de Alvarenga KAF, Miranda JWFB, et al. Risk factors for catheter-related infection in children with cancer: a systematic review and meta-analysis. Am J Infect Control. 2023;51(1):99-106. doi:10.1016/j.ajic.2022.05.005
• Kiedrowski MR, Horswill AR. New approaches for treating staphylococcal biofilm infections. Ann N Y Acad Sci. 2011;1241:104-121. doi:10.1111/j.1749-6632.2011.06281.x
• Otto M. Staphylococcal biofilms. Microbiol Spectr. 2018;6(4):10.1128/microbiolspec.gpp3-0023-2018. doi:10.1128/microbiolspec.GPP3-0023-2018
• Alfieri A, Di Franco S, Passavanti MB, et al. Antimicrobial lock therapy in clinical practice: a scoping review. Microorganisms. 2025;13(2):406. doi:10.3390/microorganisms13020406
• Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. doi:10.1086/599376
• Members of the Sous les Verrous Study Group. Antibiotic lock therapy for the conservative treatment of long-term intravenous catheter-related infections in adults and children: when and how to proceed? Guidelines for clinical practice 2020. Infect Dis Now. 2021;51(3):236-246. doi:10.1016/j.idnow.2021.02.004
• O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases. 2002;35(11):1281-1307. doi:10.1086/344188
• Shan A, Santos-Sebastian M, Saavedra-Lozano J. Lock therapy for treatment and prevention of catheter-related infections. Pediatr Infect Dis J. 2024;43(10):e358-e362. doi:10.1097/INF.0000000000004457
• Buonsenso D, Salerno G, Sodero G, et al. Catheter salvage strategies in children with central venous catheter-related or -associated bloodstream infections: a systematic review and meta-analysis. J Hosp Infect. 2022;125:1-20. doi:10.1016/j.jhin.2022.03.010
• Hecht SM, Ardura MI, Yildiz VO, Ouellette CP. Central venous catheter management in high-risk children with bloodstream infections. Pediatr Infect Dis J. 2020;39(1):17-22. doi:10.1097/INF.0000000000002495
• Centers for Disease Control and Prevention. Device-associated module CLABSI. Available at: http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf [last accessed October 2021].
• Megged O, Shalit I, Yaniv I, Fisher S, Livni G, Levy I. Outcome of antibiotic lock technique for persistent central venous catheter-associated coagulase-negative Staphylococcus bacteremia in children. Eur J Clin Microbiol Infect Dis. 2010;29(2):157-161. doi:10.1007/s10096-009-0831-4
• Adler A, Yaniv I, Solter E, et al. Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence. J Pediatr Hematol Oncol. 2006; 28(1):23-28. doi:10.1080/10910340500534282
• Celebi S, Sezgin ME, Cakir D, et al. Catheter-associated bloodstream infections in pediatric hematology-oncology patients. Pediatr Hematol Oncol. 2013;30(3):187-194. doi:10.3109/08880018.2013.772683
• Asrak HK, Belet N, Tüfekçi Ö, Özlü C, Baysal B, İnce D. Investigating the risk factors for antibiotic lock therapy failure in pediatric cancer: a single center retrospective analysis. Turk J Pediatr. 2021;63(1):86-94. doi: 10.24953/turkjped.2021.01.010
• Qureshi S, Fatima P, Mukhtar A, Zehra A, Qamar FN. Clinical profile and outcome of antibiotic lock therapy for bloodstream infections in pediatric hematology/oncology patients in a tertiary care hospital, Karachi, Pakistan. Int J Pediatr Adolesc Med. 2019;6(1):25-28. doi:10. 1016/j.ijpam.2019.01.004
• Okur Acar S, Tahta N, Böncüoğlu E, et al. Efficacy of teicoplanin lock therapy in the treatment of port-related coagulase-negative Staphylococcus bacteremia in pediatric oncology patients. J Pediatr Hematol Oncol. 2023;45(1):e17-e20. doi:10.1097/MPH.000000000000 2502
• Del Pozo JL, Cenoz MG, Hernáez S, et al. Effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of port-related coagulase-negative Staphylococcus bacteraemia: a prospective case-series analysis. Int J Antimicrob Agents. 2009;34(5):482-485. doi:10.1016/ j.ijantimicag.2009.06.020
• Guédon C, Nouvellon M, Lalaude O, Lerebours E. Efficacy of antibiotic-lock technique with teicoplanin in Staphylococcus epidermidis catheter-related sepsis during long-term parenteral nutrition. J Parenter Enteral Nutrit. 2002;26(2):109-113. doi:10.1177/0148607102026002109
• Blanco-Di Matteo A, Garcia-Fernandez N, Aguinaga Pérez A, et al. In vivo effectiveness of several antimicrobial locks to eradicate intravascular catheter coagulase-negative Staphylococcus biofilms. Antimicrob Agents Chemother. 2023;67(1):e0126422. doi:10.1128/aac.01264-22
• Kara TT, Özdemir H, Erat T, et al. Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr. 2019;61(6):895-904. doi:10.24953/turkjped. 2019.06.011
• Castagnola E, Bandettini R, Lorenzi I, Caviglia I, MacRina G, Tacchella A. Catheter-related bacteremia caused by methicillin-resistant coagulase negative Staphylococcus with elevated minimal inhibitory concentration for vancomycin. Pediatr Infect Dis J. 2010;29(11):1047-1048. doi:10.1097/INF.0b013e3181e8b74d
• Chen SH, Yang CP, Jaing TH, Lai JY, Hung IJ. Catheter-related bloodstream infection with removal of catheter in pediatric oncology patients: a 10-year experience in Taiwan. Int J Clin Oncol. 2012;17(2):124-130. doi:10.1007/s10147-011-0268-5