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. DESIGN: 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. SETTING: Level III neonatal intensive care unit. PATIENTS: One hundred three neonates were enrolled and randomly assigned to a treatment group (n = 50) or control group (n = 53). INTERVENTIONS: Fusidic acid (4 mg/mL) and heparin (10 IU/mL) lock in the treatment group. MEASUREMENTS AND MAIN 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. © 2007 The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.