Efficacy of ethanol locks in reducing central venous catheter infections in pediatric patients with intestinal failure

Jones, Brian A.; Hull, Melissa A.; Richardson, Denise; Zurakowski, David; Gura, Kathleen M.; Fitzgibbons, Shimae; Duro, Debora; Lo, Clifford; Duggan, Christopher; Jaksic, Tom

doi:10.1016/j.jpedsurg.2010.02.099

Cited by 128 publications

(122 citation statements)

References 22 publications

(32 reference statements)

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“…Ethanol alone or in combination is reported to be effective against in vitro biofilms as well as decreasing CRBSI and the need for catheter replacement in clinical trials (22,24,33). However, under our experimental conditions, it was able to reduce the biofilm but could not completely eradicate it even after 5 consecutive ALT replacements.…”

Section: Discussionmentioning

confidence: 54%

“…To evaluate the in vivo efficacy of tetrasodium EDTA as a potential adjuvant in ALT, we tested different gentamicin-based lock solutions against bioluminescent methicillin-susceptible S. aureus (MSSA) biofilms growing in TIVAP implanted in rats (n ϭ 5 rats for each treatment). In addition to solutions containing gentamicin alone, EDTA alone, or combined gentamicin-EDTA, we evaluated 70% ethanol, which was shown to be an effective antibacterial lock agent both in vitro and in vivo (12,24). We first used ALT instillations renewed every 24 h for 5 Results for CFU are means Ϯ standard deviations.…”

Section: Resultsmentioning

confidence: 99%

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Full and Broad-Spectrum In Vivo Eradication of Catheter-Associated Biofilms Using Gentamicin-EDTA Antibiotic Lock Therapy

Chauhan

Lebeaux

Ghigo

et al. 2012

Antimicrob Agents Chemother

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Biofilms that develop on indwelling devices are a major concern in clinical settings. While removal of colonized devices remains the most frequent strategy for avoiding device-related complications, antibiotic lock therapy constitutes an adjunct therapy for catheter-related infection. However, currently used antibiotic lock solutions are not fully effective against biofilms, thus warranting a search for new antibiotic locks. Metal-binding chelators have emerged as potential adjuvants due to their dual anticoagulant/antibiofilm activities, but studies investigating their efficiency were mainly in vitro or else focused on their effects in prevention of infection. To assess the ability of such chelators to eradicate mature biofilms, we used an in vivo model of a totally implantable venous access port inserted in rats and colonized by either Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, or Pseudomonas aeruginosa. We demonstrate that use of tetrasodium EDTA (30 mg/ml) as a supplement to the gentamicin (5 mg/ml) antibiotic lock solution associated with systemic antibiotics completely eradicated Gram-positive and Gramnegative bacterial biofilms developed in totally implantable venous access ports. Gentamicin-EDTA lock was able to eliminate biofilms with a single instillation, thus reducing length of treatment. Moreover, we show that this combination was effective for immunosuppressed rats. Lastly, we demonstrate that a gentamicin-EDTA lock is able to eradicate the biofilm formed by a gentamicin-resistant strain of methicillin-resistant S. aureus. This in vivo study demonstrates the potential of EDTA as an efficient antibiotic adjuvant to eradicate catheter-associated biofilms of major bacterial pathogens and thus provides a promising new lock solution.C entral venous catheters are routinely used to administer medication or fluids to patients admitted to oncology, nephrology, and intensive care units (2, 47, 52). Although these devices greatly improve patient health, their use is often associated with medical complications due to colonization by pathogenic microorganisms (38). This leads to development of complex bacterial or fungal biofilm communities that display strong tolerance toward antimicrobials (15,37,45). Biofilms are difficult to eradicate; moreover, they constitute a potential source of bloodstream infections, a leading cause of health care-associated infections in critically ill patients (29). Currently, there is no fully efficient method for treating catheter-related biofilms aside from traumatic and costly removal of colonized devices (5,11,42,49). However, recent clinical practice guidelines recommended the use of antibiotic lock therapy (ALT) for treatment of uncomplicated long-term catheter-related infections (31). ALT relies on the instillation of highly concentrated antibiotic solutions (up to 1,000 times the MIC) left to dwell in the catheter for 12 to 24 h in order to prevent or eradicate biofilm formation. Although ALT shows a high success rate for coagulase-negative staphyl...

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Section: Discussionmentioning

confidence: 54%

Section: Resultsmentioning

confidence: 99%

Full and Broad-Spectrum In Vivo Eradication of Catheter-Associated Biofilms Using Gentamicin-EDTA Antibiotic Lock Therapy

Chauhan

Lebeaux

Ghigo

et al. 2012

Antimicrob Agents Chemother

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show abstract

“…Ethanol has been demonstrated to have the ability to penetrate biofilms that form on central lines, and no bacteria or fungi have been reported to be resistant to ethanol. A recent retrospective study showed a fourfold reduction in CABSI in the cohort-administered ethanol locks (Jones et al 2010). …”

Section: Complications Of Sbsmentioning

confidence: 99%

Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition

Rao¹,

Ravikumara²,

Simmer³

2012

Neonatal Care

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“…Antibiotic catheter lock prophylaxis has also been tried [41,51,52]. Ethanol (70%) has been used and shown effect in small series of patients [51,52].…”

Section: Central Venous Cathetersmentioning

confidence: 99%

“…Ethanol (70%) has been used and shown effect in small series of patients [51,52]. Vancomycin with or without ciprofloxacin may lower the rate of CR-BSI significantly, but this may induce vancomycin resistance and is not routinely recommended [41].…”

Section: Central Venous Cathetersmentioning

confidence: 99%