A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients

Sanders, Joanne M.; Pithie, Alan; Ganly, Peter; Surgenor, Lois J.; Wilson, Rachel; Merriman, Eileen; Loudon, Gail; Judkins, Rhonda; Chambers, Stephen T.

doi:10.1093/jac/dkn284

Cited by 103 publications

(131 citation statements)

References 33 publications

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“…A prospective study involving a high-risk population of 64 patients undergoing chemotherapy via tunneled catheters showed a decrease in infections by four-fold, three in the ethanol group versus eleven in the control group, when ethanol was used as daily prophylaxis. 56 Once weekly ethanol instilled for 48 hours in patients with HD was associated with an insignificant 67% decrease in CBRSI. 49 Shorter dwell times for this agent have been postulated as prolonged ethanol exposure may lead to catheter dysfunction.…”

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confidence: 94%

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Soi¹,

Moore²,

Kumbar³

et al. 2016

IJNRD

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Catheter-related bloodstream infections are a significant source of morbidity and mortality in the end-stage renal disease population. Although alternative accesses to undergoing renal replacement therapy exist, many patients begin hemodialysis with a dialysis catheter due to logistic and physiologic factors involved in arteriovenous fistula creation and maturation. Colonization of catheters via skin flora leads to the production of biofilm, which acts as a reservoir for virulent bacteria. Preventative therapies center on appropriate catheter maintenance, infection control measures, and early removal of devices as patients transition to other access. Despite best efforts, when conservative measures fail to prevent infections in a high-risk population, antimicrobial lock therapy should be considered as an option to combat catheter-related bloodstream infections.

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confidence: 94%

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Soi¹,

Moore²,

Kumbar³

et al. 2016

IJNRD

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“…Organisms embedded in this biofilm are usually refractory to treatment with systemic antibiotic therapy alone (6,12). These organisms have reduced susceptibility to antimicrobial agents in the range of 10-to 1,000-fold compared to planktonic cells (13).…”

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confidence: 99%

“…Sterile silicone sheets (Cardiovascular Instrument Corp., Wakefield, MA) were washed with hand soap and rinsed with distilled water. Disks with a diameter of 1.5 cm were cut from the silicon sheets with a cork borer, autoclaved, and aseptically transferred to sterile 12-well tissue culture plates (Becton, Dickinson, Franklin Lakes, NJ) containing 1 ml human plasma and incubated with shaking for 24 h at 37°C (13,15). Plasma was then replaced with a 1-ml bacterial inoculum from 1 of 10 clinical MRSA isolates adjusted to 5.5 ϫ 10 5 organisms/ml, using McFarland turbidity standards, in Muller-Hinton broth (MHB), and incubated with shaking for 24 h at 37°C.…”

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confidence: 99%

Activity of Daptomycin with or without 25 Percent Ethanol Compared to Combinations of Minocycline, EDTA, and 25 Percent Ethanol against Methicillin-Resistant Staphylococcus aureus Isolates Embedded in Biofilm

Estes

Theusch

Beck

et al. 2013

Antimicrob Agents Chemother

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bCentral venous catheters commonly develop central line-associated bloodstream infections. In vitro antibiotic lock therapy (ALT) was simulated on 10 methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates imbedded in biofilm-coated silicon disks. Five days of 4-h daily exposures to daptomycin (2.5 mg/ml) in 25% ethanol or minocycline (3 mg/ml) plus 25% ethanol and 30 mg/ml EDTA resulted in significantly greater elimination of MRSA colonization than treatment with minocycline alone. Of the 5 million central venous catheters (CVCs) inserted annually, an estimated 80,000 are associated with central lineassociated bloodstream infections (CLABSIs) (1). CLABSIs are an independent risk factor for increased hospital costs and length of stay. There are four recognized routes for contamination of CVCs: (i) migration of organisms colonizing the skin at the insertion site into the catheter tract, along the catheter surface, and consequently colonization of the catheter tip (2-4); (ii) direct contamination of the catheter/catheter hub through contact with hands, contaminated fluids, or contaminated devices (5, 6); (iii) hematogenous seeding from another focus of infection (7); and (iv) rarely, contamination of intravenous infusate solutions (8). The microorganisms most commonly associated with CVC infection are Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) and coagulase-negative staphylococci (CoNS) (9-11). Within 24 h of CVC insertion, host proteins coat the catheter, forming a conditioning film in which microorganisms may bind, forming three-dimensional extracellular structures colonizing the lumen of the CVC. Organisms embedded in this biofilm are usually refractory to treatment with systemic antibiotic therapy alone (6, 12). These organisms have reduced susceptibility to antimicrobial agents in the range of 10-to 1,000-fold compared to planktonic cells (13).Published CLASBI guidelines recommend that infected longterm CVCs be removed if associated with severe sepsis, suppurative thrombophlebitis, endocarditis, bloodstream infection that continues despite 72 h of antimicrobial therapy to which the infecting microbes are susceptible, or infections due to S. aureus and that short-term CVCs be removed from patients with CLABSIs due to S. aureus (14). Unfortunately, on occasion, clinical circumstances may preclude removing the CVC for reasons of safety or feasibility. Antibiotic lock therapy (ALT) involves instilling a highly concentrated antibiotic solution into a catheter lumen and allowing the solution to dwell for a specified time period for the purpose of sterilizing the lumen and salvaging the CVC. In conjunction with systemic antimicrobial agents, ALT is indicated for CLABSIs involving long-term catheters with no signs of exit site or tunnel infection with the goal of catheter salvage.Daptomycin, a novel lipopeptide antibiotic, has potent bactericidal activity in vitro against most clinically important Grampositive pathogens, including MRSA, CoNS, vancomycin-resistant enterococci...

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“…A prospective study in which 64 immunosuppressed hematology patients with tunneled cuffed intravascular catheters inserted into the veins were randomized to prophylactic treatment using 70% ethanol or heparinized saline to prevent CR-BSI found that the development of CRI and bacteremia was significantly lower in the ethanol arm (35). Various concentrations of TSC have been used as catheter lock solutions.…”

Section: Referencesmentioning

confidence: 99%

Locking of Tunneled Cuffed Hemodialysis Catheters with a Mixture of 45% Ethanol and 4% Trisodium Citrate is Effective in Preventing Catheter-Related Infections and Thrombosis

Arıkan¹,

Oymak²,

Yılmaz³

et al. 2016

Turk Neph Dial Transpl

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OBJEcTIVE: In this study, we aimed to investigate the effect of a mixture consisting of 45% ethanol and 4% trisodium citrate (E-TSC) on the development of catheter-related infection (CRI) and catheter thrombosis in hemodialysis patients. mATErIAl and mEThODS: A total of 114 patients were included in the study. Patients were separated into two groups according to the type of catheter lock solution as the E-TSC and classic heparin groups. There were 51 patients in the E-TSC group and 63 patients in the heparin group.

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A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients

Abstract: The daily administration of ethanol locks into lumens of central venous catheters effectively reduces the incidence of CABSI.

Cited by 103 publications

References 33 publications

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Activity of Daptomycin with or without 25 Percent Ethanol Compared to Combinations of Minocycline, EDTA, and 25 Percent Ethanol against Methicillin-Resistant Staphylococcus aureus Isolates Embedded in Biofilm

Locking of Tunneled Cuffed Hemodialysis Catheters with a Mixture of 45% Ethanol and 4% Trisodium Citrate is Effective in Preventing Catheter-Related Infections and Thrombosis

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