Signorino Claudia, Fusco Eleonora, Galli Luisa, Chiappini Elena
Department of Health Sciences, Meyer Children's University Hospital IRCCS, University of Florence, Florence 50139, Italy.
Division of Pediatric Infectious Disease, Department of Health Sciences, Meyer Children's University Hospital IRCCS, University of Florence, 50139 Florence, Italy.
Antibiotics (Basel). 2023 Apr 23;12(5):800. doi: 10.3390/antibiotics12050800.
Antimicrobial lock solutions (ALT) in combination with systemic antibiotics can represent a valid option to attempt central venous catheter (CVC) salvage in the case of catheter-related and central-line-associated bloodstream infections (CRBSI and CLABSI). However, data concerning the effectiveness and safety of ALT in children are limited. We aimed to share our center's experience in order to contribute to investigations into the causes of ALT failure in the pediatric population. All children consecutively admitted to Meyer Children's Hospital, University of Florence, Italy, from 1 April 2016 to 30 April 2022, who received salvage ALT to treat an episode of CRBSI/CLABSI, were reviewed. According to ALT failure or success, children were compared with the aim of identifying the risk factors for unsuccessful ALT outcome. Data from 28 children, 37 CLABSI/CRBSI episodes, were included. ALT was associated with clinical and microbiologic success in 67.6% (25/37) of children. No statistically significant differences were observed between the two groups, successes and failures, considering age, gender, reason for use, duration, insertion, type and presence of insertion site infection of the CVC, laboratory data and number of CRBSI episodes. Nevertheless, a trend towards a higher success rate was observed for a dwell time of 24 h for the entire duration of ALT (88%; 22/25 vs. 66.7%; 8/12; = 0.1827), while the use of taurolidine and the infections sustained by MDR bacteria were associated with a tendency toward greater failure (25%; 3/12 vs. 4%; 1/25; = 0.1394; 60%; 6/10 vs. 33.3%; 8/24; = 0.2522). No adverse events, except one CVC occlusion, were observed. ALT combined with systemic antibiotics appears to be an effective and safe strategy for treating children with CLABSI/CRBSI episodes.
抗菌封管溶液（ALT）联合全身用抗生素，对于导管相关血流感染（CRBSI）和中心静脉导管相关血流感染（CLABSI）患者而言，是尝试挽救中心静脉导管（CVC）的一种有效选择。然而，关于ALT在儿童中的有效性和安全性的数据有限。我们旨在分享我们中心的经验，以便为调查儿科人群中ALT失败的原因做出贡献。回顾了2016年4月1日至2022年4月30日期间连续入住意大利佛罗伦萨大学迈耶儿童医院并接受挽救性ALT治疗CRBSI/CLABSI发作的所有儿童。根据ALT的失败或成功情况，对儿童进行比较，以确定ALT结果不成功的危险因素。纳入了28名儿童的37次CLABSI/CRBSI发作的数据。ALT使67.6%（25/37）的儿童获得了临床和微生物学成功。在年龄、性别、使用原因、持续时间、插入情况、CVC的类型和插入部位感染的存在、实验室数据以及CRBSI发作次数方面，成功组和失败组之间未观察到统计学上的显著差异。然而，在ALT的整个持续时间内，封管时间为24小时的成功率有升高趋势（88%；22/25对66.7%；8/12；P = 0.1827），而使用多粘菌素及耐多药菌引起的感染与更高的失败倾向相关（25%；3/12对4%；1/25；P = 0.1394；60%；6/10对33.3%；8/24；P = 0.2522）。除了1例CVC堵塞外，未观察到不良事件。ALT联合全身用抗生素似乎是治疗CLABSI/CRBSI发作儿童的一种有效且安全的策略。
