Vancomycin vs teicoplanin antibiotic lock therapy for pediatric coagulase negative staphylococcal central line associated bloodstream infections

Aims: Central line associated bloodstream infections (CLABSIs) are the major complication of central lines. Coagulase-negative Staphylococcus (CoNS) are the leading cause of CLABSI often necessitating line removal. While antibiotic lock therapy (ALT) is widely utilized in adults, pediatric specific data remains limited. In this study we aimed to evaluate the ALT outcomes in children with CoNS CLABSIs. Methods: Children with CoNS CLABSIs who received ≥72 hours of ALT with either vancomycin or teicoplanin between January 2020-2023 were retrospectively reviewed. Data on demographic and clinical characteristics, management strategies, and outcomes were analyzed. ALT success was defined as clinical resolution, negative follow-up blood cultures, and catheter retention. Results: Nineteen patients were included (median age 50 months; 58% female). Methicillin-sensitive CoNS (MSCoNS) were isolated in 4 (21%) cases and methicillin-resistant CoNS (MRCoNS) in 15 (79%). ALT regimens comprised vancomycin (n=9, 47%), teicoplanin (n=8, 42%), or sequential use (n=2, 11%). Overall, ALT success was 63% (12/19). Vancomycin-based ALT succeeded in 56% (5/9) vs. 62.5% (5/8) for teicoplanin (p=1.0). Success was higher in MSCoNS CLABSIs (100%) than MRCoNS (53%), though not statistically significant (p=0.245). Younger age (p=0.003) and persistent positive cultures (p=0.013) were associated with catheter loss. No infection-related mortality occurred. Recurrence occurred in 3 (16%) patients and reinfection in 5 (26%). Conclusion: ALT achieved satisfactory catheter salvage rates in pediatric CoNS CLABSI, with comparable efficacy between vancomycin and teicoplanin. Younger age and persistent bacteremia predicted failure. Vancomycin or teicoplanin based ALT can be used in selected children with CoNS CLABSI.