Short-Dwell Ethanol Lock Therapy in Children Is Associated With Increased Clearance of Central Line–Associated Bloodstream Infections

McGrath, Eric; Salloum, Ralph; Chen, Xinguang; Jiang, Yifan; Boldt-MacDonald, Kathrina; Becker, Cristie J.; Chu, Roland; Ang, Jocelyn Y.

doi:10.1177/0009922811409568

Cited by 28 publications

(60 citation statements)

References 35 publications

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“…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).…”

Section: Currently Used Approaches Do Not Specifically Target Biofilmmentioning

confidence: 99%

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

Lebeaux

Ghigo

Beloin

2014

Microbiol Mol Biol Rev

961

862

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International audienceSurface-associated microbial communities, called biofilms, are present in all environments. Although biofilms play an important positive role in a variety of ecosystems, they also have many negative effects, including biofilm-related infections in medical settings. The ability of pathogenic biofilms to survive in the presence of high concentrations of antibiotics is called "recalcitrance" and is a characteristic property of the biofilm lifestyle, leading to treatment failure and infection recurrence. This review presents our current understanding of the molecular mechanisms of biofilm recalcitrance toward antibiotics and describes how recent progress has improved our capacity to design original and efficient strategies to prevent or eradicate biofilm-related infections

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Section: Currently Used Approaches Do Not Specifically Target Biofilmmentioning

confidence: 99%

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

Lebeaux

Ghigo

Beloin

2014

Microbiol Mol Biol Rev

961

862

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“…Studies of ethanol lock as a therapeutic agent for the treatment of CR-BSI are frequently based on case reports or very short series [33] and usually selected for treatment of episodes caused by “easy to treat” microorganisms such as Coagulase Negative Staphylococcus. Under these circumstances, eradication of infections were obtained in up to 86% of the episodes in the McGrath's study [17]. The tolerance to alcohol in those studies was generally good [33], [34] but thrombosis and other adverse events were reported [15], [35].…”

Section: Discussionmentioning

confidence: 99%

Ethanol Lock Therapy (E-Lock) in the Prevention of Catheter-Related Bloodstream Infections (CR-BSI) after Major Heart Surgery (MHS): A Randomized Clinical Trial

et al. 2014

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BackgroundLock-therapy with antimicrobials has been used for the treatment and prevention of catheter-related bloodstream infections (CR-BSI). Experiences with Ethanol-Locks (E-locks) have included therapeutic interventions with variable results. Patients undergoing Major Heart Surgery (MHS) are a high-risk population for CR-BSI.The aim of this study was to assess the efficacy and tolerance to E-Locks in the prevention of CR-BSI of patients undergoing MHS.Methods and FindingsThis is an academic, prospective, randomized, non-blinded and controlled clinical trial assessing the incidence of CR-BSI of patients with E-locks (E-lock) and the tolerance to the procedure in comparison with patients receiving conventional catheter-care (CCC). Patients undergoing MHS with intravascular catheters for more than 48 hours were randomly assigned into treatment or control group by a computer-generated list of randomly assigned numbers. In the treatment group, all their catheter lumens were locked with an ethanol solution at 70% for two hours, every three days (E-Locks). The control group received conventional catheter-care (CCC).Overall, 200 patients with 323 catheters were included in the study, which was stopped after 10 months due to adverse events. Of them, 179 catheters (113 patients) had E-Locks and 144 catheters (87 patients) were CCC. Euroscore Surgical Risk in both groups was 4.04 vs 4.07 p = 0.94 respectively. The results for the E-Locks and CCC were as follows: Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2 (p = 0.33), catheter tip colonization 14 (7.8%) vs 6 (4.2%) patients (p = 0.17), median length of hospital stay, 15 vs 16 days (p = 0.77). Seven patients (6.19%), all in the ethanol branch, had to discontinue the trial due to intolerance or adverse events.ConclusionsWe do not recommend prophylaxis of CR-BSI with ethanol-lock on a routine basis in patients undergoing Major Heart Surgery.Trial RegistrationClinical Trials.gov NCT01229592

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“…A pesar de ello, es cierto que la posibilidad de que el sellado con etanol incremente el riesgo de oclusión del catéter existe y debería analizarse de forma prospectiva y sistemática en futuros ensayos clínicos. Por último, el uso de etanol se ha asociado también a la aparición de otros efectos adversos sistémicos, como alteraciones en la función hepática, relacionadas, en forma, sobre todo, de elevación de transaminasas (31,44,45). Recientemente Mermel ha publicado una revisión en la que se recogen todos los posibles efectos adversos asociados al uso de etanol que se han comunicado en los últimos 10 años (46).…”

Section: Etanolunclassified

“…El problema es que existe una gran heterogeneidad en cuanto al diseño del estudio, el procedimiento de sellado, la concentración del etanol, el tiempo de sellado, el tiempo de intervención, las variables de resultado y el seguimiento, entre otros aspectos (Tabla VI) (30,31,45,(81)(82)(83)(84)(85)(86). También el tipo de pacientes incluidos eran muy diferentes.…”

Section: Sellados Con Etanolunclassified

Sellado con antibióticos o antisépticos en pacientes pediátricos con nutrición parenteral domiciliaria. Puesta al dí

et al. 2016

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Introduction: Home parenteral nutrition has become the mainstay for the support of patients with severe chronic intestinal failure. Despite the signifi cant advances that have occurred in recent decades in terms of vascular access and parenteral solutions, catheter-related bloodstream infections remain one of the most important complications. Antiseptic lock therapies, as ethanol or taurolidine; and antibiotic lock therapies are used in order to prevent or treat these infections. Objective: The aim of this article is to review the available scientifi c evidence regarding the use of antiseptic and antibiotic lock therapies in the management of pediatric patients with home parenteral nutrition. Material and methods: The use of ethanol or taurolidine lock therapy would be suggested in order to prevent catheter-related bloodstream infections in patients with home parenteral nutrition who have suffered from more than one infection in the previous year or in at-risk patients. Antibiotic locks are used for the treatment of catheter-related bloodstream infections due to S. coagulase negative and gram-negative bacilli in conjunction with systemic antimicrobial therapy, for whom catheter salvage is the goal. Catheter removal is recommended when there are signs of exit site or tunnel infection or the infection is due to S. aureus or Candida species. Conclusion: Despite the fact that evidence based data on the topic is scarce, there are a growing number of publications that support the use of antibiotics or antiseptic locks for the prevention or treatment of catheter-related infections in home parenteral nutrition patients, in whom catheter maintenance is a cornerstone for survival.

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Short-Dwell Ethanol Lock Therapy in Children Is Associated With Increased Clearance of Central Line–Associated Bloodstream Infections

Abstract: These findings suggest the potential benefit of short-dwell ELT combined with systemic antimicrobials in CLABSI treatment. Randomized controlled trials are needed.

Cited by 28 publications

References 35 publications

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

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

Ethanol Lock Therapy (E-Lock) in the Prevention of Catheter-Related Bloodstream Infections (CR-BSI) after Major Heart Surgery (MHS): A Randomized Clinical Trial

Sellado con antibióticos o antisépticos en pacientes pediátricos con nutrición parenteral domiciliaria. Puesta al dí

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