The effectiveness of systemic antibiotic therapy with and without ethanol-locked solution in the treatment of hemodialysis-related catheter infection

Abstract

Bacterial overgrowth in the inner layer of the catheter as a biofilm is highly encountered in routine medical care, and it may occur in a few days after inserting a catheter as an access in hemodialysis (HD) patients. Catheter-induced bacteremia is often due to the development of biofilms. Locking catheters with antimicrobial agents is an effective way of reducing the risk of catheter-related infection. In a controlled, randomized clinical trial, 64 chronic HD patients (32 men and 32 women with a mean age of 57.5 ± 15.6 years) were divided into case and control groups, with 32 patients in each group. The case group received systemic antibiotic and a lock of catheters with 60% ethanol and the control group received only systemic antibiotic. The results were evaluated after three weeks of treatment. The success rate of clearing infection in group A (29 patients) and group B (18 patients) was 90.6% and 56.2%, respectively (P = 0.002). We conclude that the significant difference in the success rate of clearing catheter infection in HD patients is due to the use of 60% ethanol-lock along with antibiotic therapy, and suggest this for routine use.

Factors Associated with Infection of the Central Venous Catheter for Hemodialysis in Ouagadougou (Burkina Faso)

“…Staphylococcus aureus is the most frequently identified germ, in more than 70% of cases according to some authors [15] [20] [21]. However, our results are consistent with other authors who have noticed a predominance of Staphylococcus non-aureus [22] [23].…”

Role of short-dwell daily ethanol-lock therapy in the management of hemodialysis tunneled cuffed catheter-related bloodstream infection

“…The success rates were comparable to other studies using antibiotic-lock therapy. 12,24,25 Similar success rates were observed with prior ELT in silicone central venous catheters (majority were for chemotherapy/ parenteral nutrition) 17,18,20 The majority of the previous studies were either uncontrolled or had a smaller number of patients recruited. Our study results were also comparable to a recent systemic review of nine studies of non-dialysis patient groups evaluating ELT in the treatment of CRBSI.…”

“…[17][18][19] There is a paucity of data 21 on the efficacy of ELT in hemodialysis patients with CRBSI and there is a safety concern in prolonged exposure of higher concentrations of ethanol to polyurethane catheter. [20][21][22] Although conventionally, Polyurethane catheters are considered incompatible with ethanol for a prolonged period; one recent study found no significant change in the integrity of polyurethane catheters after ethanol exposure for short-term and up to 9 weeks. 23 As biofilm elimination by 70% ethanol requires a shorter period compared to other agents; our study used a short dwell of 70% ethanol to eliminate biofilm-associated CRBSI simultaneously with ensuring the safety of polyurethane catheters to exposure of ethanol.…”

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

“…These and similar findings are likely to lead to a revision of future guidelines to support routine use of ALT on patients with long term CVCs. In patients with established CRBSI, Khosroshahi et al demonstrated a significant difference in the success rate of clearing catheter infection in hemodialysis patients with use of 60% ethanol-lock (antiseptic solution) along with systemic antibiotic therapy, and suggested this for routine use ( 70 ). A recent meta-analysis of pediatric data showed the addition of ALT to be superior to systemic antibiotics alone for the management of CRBSI and was also associated with less recurrence when compared to patients who were treated with systemic antibiotics alone ( 35 ).…”