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

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

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