Effect of Vancomycin After Catheter Replacement

Effect of Single-dose Vancomycin After Catheter Replacement for Suspected Central Line-associated Bloodstream Infection (CLABSI) on Resolution of Infection in Critically Ill Patients: A Single Center Randomized Open Label Controlled Trial

Randomized controlled trial of the effect of a single-dose intravenous Vancomycin after catheter replacement for suspected central line-associated bloodstream infection on resolution of infection in critically ill patients.

Patients on the local intensive care unit with suspicion of central line-associated bloodstream infection will be randomized to standard of care consisting of catheter replacement and blood and catheter tip cultures and to standard of care plus a single-dose vancomycin. The effect of the intervention on resolution of humoral inflammation and negativity of blood cultures will be assessed after 48 and 96 hours.

Inclusion Criteria:

Suspected central line-associated bloodstram infection defined as:

• Catheterization with a non-tunneled CVC and
• Clinical signs of local catheter infection or any increase in humoral inflammatory markers (PCT, CRP, WBC) or elevated body temperature ≥ 38.3°C not otherwise explained.

Baseline CRP at screening ≥ 100 mg/L

Exclusion Criteria:

• known positive blood cultures at the time of randomization
• High risk situation warranting immediate empiric antibiotic therapy:
• endovascular implant (prosthetic valve, pacemaker, vascular graft)
• high-risk for endocarditis warranting endocarditis-prophylaxis
• Septic shock
• Catheter replacement not feasible or no further indication for central venous catheterization
• Known hypersensitivity to vancomycin or any component of the formulation.
• Administration of Vancomycin, Teicoplanin, Daptomycin or Linezolid <48 hours before enrolment.
• Enrolment in another clinical study
• Pregnancy