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Effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of port-related coagulase-negative staphylococci bacteraemia: a prospective case-series analysis

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Abstract

The aim of this study was to analyse the effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of coagulase-negative staphylococci (CoNS) venous access port-related bloodstream infection (BSI). The study included 44 consecutive patients during a 36-month prospective case-series study. The primary endpoint was failure to cure. Treatment was successful in 39 patients. At the end of the study, the cumulative port survival rate was 100% in the teicoplanin lock group compared with 77% in the vancomycin lock group (P = 0.06). In the Cox regression analysis, fever beyond 48 h of treatment was a significant predictor of treatment failure (P = 0.02). Use of vancomycin or teicoplanin locks had an effectiveness of 88.6% in the treatment of CoNS port-related BSI. Teicoplanin locks reduced the failure rate from 18.5% to 0% compared with vancomycin locks. The presence of fever after beginning antimicrobial lock therapy was associated with treatment failure.

Introduction

Use of venous access ports has increased over the last decade and nowadays they are commonly used in the management of oncology patients. Port-related infections increase hospital-related costs and are a well-recognised source of patient morbidity and mortality. Coagulase-negative staphylococci (CoNS) are the most common pathogen involved. Removal of a surgically implantable vascular device is often a management challenge and it is important to determine the role of conservative therapeutic approaches. Antibiotic lock therapy (ALT) is recommended in guidelines as treatment for patients with CoNS catheter-related bacteraemia [1], [2], [3]. Success rates have varied substantially among studies and, even in non-complicated patients, a 100% rate has not been reached [4]. Vancomycin is considered the agent of choice to perform antimicrobial locks when staphylococci are involved. Teicoplanin is a glycopeptide with an antimicrobial spectrum similar to that of vancomycin that has shown better binding to siliconised polymers [5]. This phenomenon might be relevant in the effectiveness of antimicrobial locks to treat port-related bloodstream infections (BSIs) since silicone is the main inner surface port component. However, there is a lack of clinical research into this topic. The aim of this study was to compare the effectiveness of teicoplanin lock therapy versus vancomycin lock therapy in the treatment of CoNS venous access port-related BSI.

Section snippets

Study location

The study was carried out in a 350-bed university hospital in which approximately 300 venous access ports are implanted every year. All participants provided informed consent.

Study design and patients

An observational study was prospectively conducted including consecutive patients with port-related bacteraemia diagnosed at Clínica Universidad de Navarra (Pamplona, Spain). All hospitalised and non-hospitalised patients with a venous access port in place were eligible for inclusion. During the 36-month study period (1

Results

In total, 90 patients were diagnosed with port-related bacteraemia. However, 28 patients with port-related BSIs other than CoNS and 5 patients with polymicrobial BSIs were excluded. In addition, 13 patients were also excluded because of the presence of pocket or subcutaneous tract infection (10), unstable clinical status (2) or existence of a metastatic complication (1). Thus, 44 patients were diagnosed with CoNS port-related BSI and included in the study. Table 1 illustrates that both

Discussion

To the best of our knowledge, this is the first study to compare vancomycin and teicoplanin as lock solutions for the treatment of CoNS port-related BSI. Moreover, this is the largest prospective study on the outcome of port-related CoNS BSI treated with ALT. The present study shows that in patients with a CoNS port-related BSI, the use of vancomycin or teicoplanin locks has an effectiveness of nearly 90%. Moreover, this study shows that teicoplanin locks reduce the failure rate to cure the

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