Antibiotic lock therapy for catheter-related bloodstream infections in pediatric hemato-oncology: a retrospective analysis

Abstract

This study aims to comprehensively evaluate the efficacy and safety of Antibiotic Lock Therapy (ALT) in pediatric patients and to better clarify its role in catheter management. Methods This retrospective single-center study was conducted between October 2021 and October 2024. Of 53 eligible patients, 47 received ALT and constituted the primary analysis population for treatment outcomes; 6 patients underwent immediate catheter removal without ALT and were excluded from the ALT efficacy analysis. Demographic, clinical, and microbiological data from all patients were collected. Results A total of 70 catheter-related bloodstream infection (CRBSI) episodes were identified among 47 patients, corresponding to an incidence rate of 12.79 per 1,000 catheter-days. The most frequently isolated pathogens were coagulase-negative staphylococci (CoNS), followed by gram-positive bacilli and Klebsiella spp. Antibiotic Lock Therapy (ALT) was administered to 47 patients and was successful in 70.2% of these cases (33/47) ( p = 0.038). Among patients who did not receive ALT and required catheter removal, Klebsiella spp. and methicillin-resistant CoNS (MRCoNS) were the predominant organisms associated with sepsis and infection. In patients requiring catheter removal despite receiving ALT, gram-negative organisms were the most common pathogens, followed by gram-positive bacilli. Notably, infections most frequently developed between days 11 and 45 of catheter use, indicating a critical high-risk window for catheter-related infections. Conclusion Catheter-related infections remain a significant clinical challenge in pediatric hematology–oncology patients. Our findings suggest that ALT was associated with catheter retention in a considerable proportion of patients; however, given the retrospective design and potential for confounding by indication, this observation should be interpreted cautiously rather than as a definitive efficacy claim. The identification of a high-risk period between days 11 and 45 may support closer monitoring and earlier intervention. Further prospective studies with standardized selection criteria are required to validate and standardize the use of ALT in this vulnerable population.