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Usefulness of daptomycin lock therapy in children with catheter-related bacteremia after failed vancomycin lock
Celia Permuy1, Jone Ruiz-Azcárate1, Mercedes Sampedro1
1Paediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz., Paseo de La Castellana 261, 28046, Madrid, Spain.
Insights
Daptomycin lock therapy shows promise for treating catheter-related bacteremia (CRB) in children when vancomycin fails. This approach successfully cleared infections in three pediatric patients, preventing catheter removal and relapse.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Medical Device Infections
Background:
- Catheter-related bacteremia (CRB) poses significant risks in patients with long-term catheters.
- Antibiotic lock therapy (ALT) is a common treatment, with vancomycin frequently used for Gram-positive infections.
- Emerging evidence suggests daptomycin may be more effective than vancomycin against bacterial biofilms.
Purpose of the Study:
- To evaluate the efficacy of daptomycin lock therapy in pediatric patients with CRB.
- To investigate daptomycin's potential as an alternative ALT when standard therapies fail.
- To address the lack of data on daptomycin ALT use in pediatric populations.
Main Methods:
- A descriptive study was conducted at a tertiary hospital.
- Included pediatric patients (<16 years) treated with daptomycin lock therapy between 2018 and 2022.
- Case series involving three pediatric patients with confirmed CRB.
Main Results:
- Three pediatric patients with Coagulase-negative Staphylococci (CoNS) CRB initially received vancomycin ALT without achieving negative blood cultures.
- Switching to daptomycin lock therapy resulted in negative blood cultures in all three patients.
- No relapses or need for catheter removal were observed after daptomycin treatment.
Conclusions:
- Daptomycin lock therapy appears effective for treating pediatric CoNS catheter infections.
- Consider daptomycin lock therapy in children with CRB, particularly when vancomycin ALT has failed.
- This study highlights daptomycin's potential in managing challenging pediatric catheter-related infections.
Purpose:
Catheter-related bacteremia (CRB) is a significant cause of morbidity, resource expenditure and prolonged hospital stays in patients with long-term catheters, whose numbers have increased considerably in recent years. Antibiotic lock therapy reaches high concentrations in the catheter, allowing good penetration into the biofilm, being vancomycin the most commonly used one in gram-positive infections. Several authors have recently reported the superior in vitro efficacy of daptomycin compared with vancomycin, especially for eradicating biofilms. Although there is some data on the use of daptomycin for antibiotic lock in animal models and adults, there are no data on its use in children.
Methods:
A descriptive study was conducted in a tertiary hospital, including patients younger than 16 years in whom daptomycin lock therapy was employed between 2018 and 2022.
Results:
We report three pediatric patients in whom CRB was confirmed on admission by paired blood cultures positive for CoNS sensitive to vancomycin, daptomycin and linezolid. All patients started vancomycin lock therapy and systemic antibiotic therapy with proven sensitivity for the isolated bacteria, without achieving negative blood cultures. Due to the persistence of positive cultures, vancomycin lock therapy was replaced by daptomycin, and blood cultures turned negative, with no relapses or need for catheter removal.
Conclusion:
The use of daptomycin lock therapy could be considered in children with CoNS catheter infection, especially when other antibiotic lock therapy had failed.
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