Amikacin-heparin lock for prevention of catheter-related
bloodstream infection in neonates with extended umbilical venous catheters use:
A randomized controlled trial
Affiliations: Neonatal Care Unit, Faculty of Medicine, Mansoura
University Children's Hospital, Mansoura, Egypt | Department of Medical Microbiology and Immunology,
Faculty of Medicine, Mansoura University, Mansoura, Egypt
Note: [] Corresponding author: Dr. Wael Seliem, Mansoura University
Children's Hospital, Al Gomhoria St., Mansoura, Egypt. Tel.: +20 50 2239618;
Fax: +20 50 2234092; E-mail: wseliem@hotmail.com, wseliem@mans.edu.eg
Abstract: Objective: To ascertain the safety and the efficacy of
amikacin-heparin lock technique in the prevention of
catheter-related-bloodstream infection (CRBSI) in neonates with extended
umbilical venous catheters (UVCs) use and to determine the applicability of
keeping UVCs in situ for 14 days. Methods: A randomized controlled –
blind trial was conducted on neonates who were expected to require UVC for at
least 48 hours. Babies were randomized to have the catheter locked twice daily
for 20 minutes either with heparinized normal saline (n=42) or heparinized
saline containing amikacin 1.5 mg/mL (n=41). The blood glucose level was
measured at the end of indwelling time and any episode of hypoglycemia was
recorded. Doppler ultrasound was performed for the umbilical, portal and
inferior vena cava veins. Surveillance cultures were taken from enrolled
patients' skin to detect colonization by amikacin-resistant organisms. The UVCs
were removed whenever their use was deemed unnecessary or at the 14th day after insertion. Results: There were 4 CRBSI episodes (definite, probable) in
amikacin-heparin lock group and 12 episodes in the saline-heparin lock group
[RR: 0.34; 95% CI: (0.02–0.65); p=0.01]. Density incidence of CRBSIs
was 3.6 per 1000 catheter days in amikacin-heparin lock group and 18.4 per 1000
catheter days in saline-heparin lock group [RR: 0.19 CI: (0.08–0.67), p=
0.02]. No amikacin-resistant organisms were recovered from any of the cultures.
Transient asymptomatic hypoglycemia occurred in 13 (15.6%) neonates at the
end of catheter-lock period. No portal or inferior vena cava thrombosis was
detected in any of our babies. Conclusions: Amikacin-heparin lock reduced
the incidence of CRBSI in neonates with extended UVCs use, without promoting
amikacin resistance.
Keywords: Amikacin, antibiotic lock, catheter related bloodstream infection, neonate
