Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients

Abstract

Objectives: To use the ethanol-lock technique (in conjunction with systemic antibiotics) to salvage central lines from removal and to prevent persistence of catheterrelated infections among pediatric patients with longterm intravascular devices. Patients: Forty children with diverse underlying disorders were treated for 51 catheter-related infections using the Childrens Hospital Los Angeles ethanol-lock technique.Interventions: Eligible infected central lines were instilled with a dose volume of 0.8 to 1.4 mL of 70% ethanol into the catheter lumen during 12 to 24 hours and then withdrawn. The volume of ethanol used was based on the type of intravascular device. Main Outcome Measures:Clearance of infection and incidence of recurrence.Results: Of the 51 ethanol-lock treatments in 40 children, no catheters were removed because of persistent infection. Eighty-eight percent (45/51) of the treated episodes cleared without recurrence (defined as a relapse within 30 days with the same pathogen). Twelve (75%) of 16 polymicrobial isolates and 33 (94%) of 35 monomicrobial isolates were successfully treated. There were no adverse reactions or adverse effects reported. Conclusion:This retrospective study supports the use of the ethanol-lock technique in conjunction with systemic antibiotics as an effective and safe method to retain the use of a previously infected central venous catheter, decrease the need for line removal, and eradicate persistent pathogens in catheter-related infections.

Biofilm-Related Infections: Bridging the Gap between Clinical Management and Fundamental Aspects of Recalcitrance toward Antibiotics

“…Aside from commonly used antimicrobials in ALT, ethanol and daptomycin have recently been used for conservative treatment (see the previous section for daptomycin data). However, clinical data are still needed in order to recommend ethanol as a first-line compound for ALT (245)(246)(247).…”

Reduced Biocide Susceptibility in Candida albicans Biofilms

“…H 2 O 2 has been used for disinfection of oral hygiene devices and contact lenses (6,28,40). Also, the utility of ethanol (25 to 70%) as central venous catheter lock therapy is under investigation (1,31,35). The current study suggests that azole drugs, such as fluconazole, may act to enhance the activities of these biocides when they are used to prevent or treat fungal biofilms.…”

Persistent Bloodstream Infection with Kocuria rhizophila Related to a Damaged Central Catheter

“…Afterward, seven other septic episodes with K. rhizophila (two in 2007, four in 2008, and one in 2009) were observed and resolved with the same antimicrobial therapy. Since it was assumed that colonization of the catheter was the cause of sepsis, ethanol locks (70% ethanol was instilled into the catheter lumen for 12 h and was then withdrawn from the catheter lumen; then, an isotonic sodium chloride flush was performed) were made in the catheter during the last four episodes associated with systemic antibiotics (17). At the time of the last septic event in 2009, a hole in the catheter was detected and repaired using a specific repairing kit.…”