ROLE OF ANTIBIOTIC LINE LOCKS IN THE TREATMENT OF INFECTED CENTRAL VENOUS ACCESS DEVICES

You are the specialist registrar in paediatrics in a district general hospital which provides shared care for paediatric oncology patients. A girl on cyclical maintenance chemotherapy for acute lymphoblastic leukaemia was admitted 10 days ago with neutropenic sepsis. Blood culture from her Hickman line at admission had grown Staphylococcus epidermidis. She was treated according to the sensitivity pattern of the organism. She is now free of signs of systemic infection. However, the most recent blood culture from her Hickman line continues to grow S epidermidis. Concurrent peripheral venous blood cultures are sterile.

At this point, you are keen to remove the central line. However, her parents want to avoid line removal as venous access has always been extremely difficult for her. You consult the oncologist at her referral centre, who suggests a trial of antibiotic lock of the Hickman line. The microbiologist at your hospital is not in favour of this approach and wants the colonised line to be removed immediately. You are unsure about the best therapy in this situation. You decide to do a literature search on the benefits and risks of antibiotic line lock technique (ALLT) and critically appraise the evidence.

STRUCTURED CLINICAL QUESTION

In a stable child with a central venous catheter colonised by bacteria [subject], is antibiotic line lock [intervention] useful to eradicate the colonisation [outcome]?

SEARCH STRATEGY AND OUTCOME

Secondary sources

Cochrane library, Best Evidence and Clinical Evidence were searched. No relevant articles were found.

Primary sources

MEDLINE (1966 …