The Impact of Ethanol Lock Therapy on Length of Stay and Catheter Salvage in Pediatric Catheter-Associated Bloodstream Infection

Chaudhary, Manu; Bilal, Muhammad Fawad; Du, Wei; Chu, Roland; Rajpurkar, Madhvi; McGrath, Eric

doi:10.1177/0009922814533591

Cited by 10 publications

(14 citation statements)

References 32 publications

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“…ELT with concomitant systemic antimicrobials has become an accepted local standard of care (SOC) since 2007 for the treatment of CRI in hemodynamically stable patients in the H/O/HSCT unit where catheter salvage is desired. 14 - 17 , 20 In this study, the research team compared hospital LOS, ALOS, and hospital costs of study participants in 2 study arms utilizing short-dwell ELT (4- to 24-hour dwell times per day, per lumen) at varying timing. The broad range of dwell times accommodated some patients with multiple concurrent infusion needs with limited intravenous access.…”

Section: Methodsmentioning

confidence: 99%

“…Enrolled participants were assigned to a treatment arm per randomization lists provided by the study biostatistician. Randomization procedure was stratified by immunocompromised state (Yes/No) 20 and a randomization list for each of the 2 groups (immune-compromised Yes/No) was generated with a 1:1 allocation ratio.…”

Section: Methodsmentioning

confidence: 99%

“…In prior work, we retrospectively reviewed H/O/HSCT patients admitted to Children’s Hospital of Michigan (CHM) for CRI, and our data suggested a trend that ELT in combination with systemic antimicrobials had a higher salvage rate for infected catheters over antimicrobials alone. 20 Additionally, patients with earlier ELT (after 1 positive culture vs after persistent positive cultures) had a significantly ( P = .018) shorter hospital length of stay (LOS) and attributable length of stay (ALOS) ( P = .022), which was defined as time from admission to first negative culture. These findings formed the foundation for the present study.…”

Section: Introductionmentioning

confidence: 99%

“…These findings formed the foundation for the present study. 20 In this study, we hypothesized that short-dwell preemptive ELT placed within 24 to 36 hours of admission (arm 1) versus ELT placement at time of first positive culture (arm 2) along with systemic antibiotics for CRI treatment in the pediatric H/O/HSCT population would result in shorter hospital LOS and lower hospital costs. A single-center, randomized trial was carried out in a pediatric H/O/HSCT unit at CHM over a 2-year period to test this hypothesis.…”

Section: Introductionmentioning

confidence: 99%

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Preemptive Ethanol Lock Therapy in Pediatric Hematology/Oncology Patients With Catheter-Associated Bloodstream Infection: Impact on Length of Stay, Cost, and Catheter Salvage

McGrath

Rajpurkar

2017

Clin Pediatr (Phila)

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Background. Ethanol lock therapy (ELT) with systemic antimicrobial therapy is a promising therapy for catheter-related infection (CRI). The impact of ELT timing on treatment efficacy and costs is unknown. Procedures. A prospective study was conducted in the Hematology/Oncology Unit at the Children’s Hospital of Michigan. Patients with suspected CRI were randomized to Preemptive ELT arm or Rescue ELT arm after positive culture. Results. Five cases in Preemptive arm and 9 in Rescue arm had a confirmed CRI. All cases cleared infection with line salvage with no adverse events due to ELT or recurrence within 14 days. Our data showed a trend toward 36% reduction in average hospital costs and 40% reduction in average length of stay in Preemptive arm over Rescue arm. Conclusion. Although a small study, our data on preemptive ELT with systemic antimicrobial therapy suggest a potentially important treatment strategy in reducing length of stay as well as hospital costs.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preemptive Ethanol Lock Therapy in Pediatric Hematology/Oncology Patients With Catheter-Associated Bloodstream Infection: Impact on Length of Stay, Cost, and Catheter Salvage

McGrath

Rajpurkar

2017

Clin Pediatr (Phila)

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“…CLABSIs caused by virulent species are especially difficult to manage and likely will require CVC removal. Therapeutic ethanol, with considerably longer dwell times in comparison to prophylactic use, has proven beneficial to salvaging CVCs 84 , 98 – 100 . Therapeutic use of ethanol is novel and brings new hope for children with CLABSIs that are persistent and unresponsive to systemic antibiotic therapy.…”

Section: Prevention Strategies—ethanol Lock Therapymentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

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Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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Factors predicting efficacy of ethanol lock therapy as catheter salvage strategy for pediatric catheter‐related infections

Ashkenazi‐Hoffnung

Shecter

De-Vries

et al. 2020

Pediatric Blood & Cancer

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Aim Catheter‐related infections are difficult to cure, and failure rates are high. We aimed to evaluate the efficacy and safety of ethanol lock therapy (ELT) as catheter salvage strategy in children with central‐line‐associated bloodstream infection (CLABSI), and to identify factors associated with treatment failure. Methods Data were collected of all the children who received ELT for treatment of CLABSI during 2013‐2018 due to failure of standard therapy or multiple catheter‐related infections. Univariate and multivariate analyses of risk‐factors for ELT failure were performed. Catheter salvage rates were compared to those achieved using systemic antimicrobials alone in an historical control group. Results A total of 123 ELT episodes among 95 patients were analyzed. The majority of patients had underlying hemato‐oncological disorders. Approximately half the episodes occurred in patients with implantable ports. Early and late treatment failure rates of ELT were 16% (20/123) and 7% (9/123), respectively. Overall, successful catheter salvage was achieved in 78% (96/123) of episodes, compared to 54% using systemic antimicrobials alone (P < .001), including mycobacterium, candida, and most staphylococcus aureus infections. Adverse events were reported in 9% (11/123) of episodes and were mostly mechanical. Multivariate analysis identified four risk factors for ELT failure: Gram‐positive bacteria, elevated C‐reactive protein, signs of tunnel infection, and low absolute neutrophil counts. Conclusions Our findings support the use of ELT for catheter salvage in children with CLABSI who failed standard therapy or had multiple catheter‐related infections. The identified variables associated with ELT failure may help identify patients who can most benefit from ELT.

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The Impact of Ethanol Lock Therapy on Length of Stay and Catheter Salvage in Pediatric Catheter-Associated Bloodstream Infection

Abstract: Earlier initiation of ELT may decrease ALOS.

Cited by 10 publications

References 32 publications

Preemptive Ethanol Lock Therapy in Pediatric Hematology/Oncology Patients With Catheter-Associated Bloodstream Infection: Impact on Length of Stay, Cost, and Catheter Salvage

Preemptive Ethanol Lock Therapy in Pediatric Hematology/Oncology Patients With Catheter-Associated Bloodstream Infection: Impact on Length of Stay, Cost, and Catheter Salvage

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Factors predicting efficacy of ethanol lock therapy as catheter salvage strategy for pediatric catheter‐related infections

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