Treatment and secondary prophylaxis with ethanol lock therapy for central line-associated bloodstream infection in paediatric cancer: a randomised, double-blind, controlled trial

Wolf, Joshua; Connell, Tom; Allison, Kim; Li, Tang; Richardson, Julie; Branum, Kristen; Borello, Eloise; Rubnitz, Jeffrey E.; Gaur, Aditya H.; Hakim, Hana; Su, Yin; Federico, Sara M.; Méchinaud, Françoise; Hayden, Randall T.; Monagle, Paul; Worth, Leon J; Curtis, Nigel; Flynn, Patricia M.

doi:10.1016/s1473-3099(18)30224-x

Cited by 54 publications

(59 citation statements)

References 29 publications

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“…The possibility of a small amount of flush at 10 ml was also conceivable. However, the blockage rate was very high only in this paper . Usually, in the treatment of oncology patients, various drugs, including anti‐cancer agents are used, but the relationship between the anti‐cancer drugs and catheter blockage is not mentioned and, therefore, needs to be studied in the future.…”

Section: Discussionmentioning

confidence: 85%

“…of treatment that locks for more than 2 h with 70% ethanol after ELT in childhood cancer patients. However, the majority of the reports were retrospective studies and lock time and duration were not constant . Therefore, The Japan Society for Metabolism Research in Pediatric Surgery launched the CVC‐ELT Working Group in 2012 to create a unified protocol with the aim of preserving long‐term, indwelling CVC in children with CRBSI.…”

Section: Discussionmentioning

confidence: 99%

“…In past reports, the response rate of ELT was 44– 92%, and the catheter preservation rate was 77‐ 100%. Direct comparisons were difficult because the locking time varied from 2‐24 h, the period varied from 1‐ 14 days, and patients’ conditions also varied . In particular, the effective rate was very low in two reports on oncology patients .…”

Section: Discussionmentioning

confidence: 99%

“…At the time of neutropenia, blood‐culture negative conversion took a long time, which seemed to have a strong impact on the response rate of ELT. Wolf et al rejected the role of neutropenia . Although the effect of ELT varies greatly, depending on the duration of neutropenia and the type of bacteria involved, a more detailed examination is needed .…”

Section: Discussionmentioning

confidence: 99%

“…One suggested cause was that alcohol remained in the catheter. Wolf et al reported that ethanol remained in the CVC lumen, although the lock volumes had been flushed . They flushed CVC with 10 mL saline (1 kg/kg for children <10 kg) before and after locking.…”

Section: Discussionmentioning

confidence: 99%

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Ethanol lock therapy in pediatric patients: A multicenter prospective study

Chiba

Yonekura

Kaji

et al. 2020

Pediatrics International

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Background Ethanol lock therapy (ELT) has been performed for the purpose of preserving central venous catheters (CVC) in central venous catheter‐related blood stream infection (CRBSI), but evidence for its effectiveness is not established. We conducted a multicenter, prospective study on the ELT protocol to ascertain its safety and effectiveness against CRBSI. Methods The subjects were patients aged over 1 year with potential for developing CRBSI who had long‐term indwelling silicone CVCs. After culturing the catheterized blood, a 70% ethanol lock was performed daily for 2–4 h for 7 days. The effectiveness rate of ELT for single and multiple courses, the presence or absence of relapse of CRBSI within 4 weeks of treatment, and whether the CVC could be salvaged after 4 weeks were examined. Results From September 2014 to August 2018, 49 cases from six hospitals were enrolled in the study. Catheter blockage was seen in one case and the CVC was removed. A single course of ELT was effective in episodes 88% (42/48). In the remaining three episodes that failed after a single course of ELT, a second ELT was performed; however, all were ineffective. In episodes 93% (40/42), no CRBSI relapse was seen up to 4 weeks after the end of treatment. In episodes 84% (41/49), the catheter could be preserved for 4 weeks or more after the end of treatment. Facial flushing was seen in two cases as an adverse event; however, this was transient and soon disappeared. Conclusion ELT is effective for 88% of CRBSI and 84% of catheters can be salvaged; therefore, this protocol is considered useful. Trial registration: UMIN000013677.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ethanol lock therapy in pediatric patients: A multicenter prospective study

Chiba

Yonekura

Kaji

et al. 2020

Pediatrics International

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Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018

et al. 2020

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IMPORTANCE Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients. OBJECTIVE To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals. DESIGN, SETTING, AND PARTICIPANTSThis time series study included 176 US hospitals reporting pediatric health care-associated infection surveillance data to the National Healthcare Safety Network from January 1, 2013, to June 30, 2018. Patients aged 18 years or younger admitted to PICUs or level III NICUs were included in the analysis. MAIN OUTCOMES AND MEASURESThe primary outcomes were device-associated rates of CLABSI in NICUs and PICUs and CAUTI in PICUs (infections per 1000 device-days). Secondary outcomes included population-based rates (infections per 10 000 patient-days) and device utilization (device-days per patient-days). Regression models were fit using generalized estimating equations to assess yearly changes in CLABSI and CAUTI rates, adjusted for birth weight (Յ1500 vs >1500 g) in neonatal models. RESULTSOf the 176 hospitals, 132 hospitals with NICUs and 114 hospitals with PICUs contributed data. Of these, NICUs reported 6 064 172 patient-days and 1 363 700 central line-days and PICUs reported 1 999 979 patient-days, 925 956 central catheter-days, and 327 599 indwelling urinary catheter-days. In NICUs, there were no significant changes in yearly trends in device-associated (incidence rate ratio [IRR] per year, 0.99; 95% CI, 0.95-1.03) and population-based (IRR, 0.96; 95% CI, 0.92-1.00) CLABSI rates or central catheter utilization (odds ratio [OR], 0.97; 95% CI, 0.95-1.00). Results were similar in PICUs, with device-associated (IRR, 1.03; 95% CI, 0.99-1.07) and population-based (IRR, 1.03; 95% CI, 0.99-1.07) CLABSI rates and central catheter utilization (OR, 0.99; 95% CI, 0.97-1.01) remaining stable. While device-associated CAUTI rates in PICUs also remained unchanged over time (IRR, 0.97; 95% CI, 0.91-1.03), population-based CAUTI rates significantly decreased by 8% per year (IRR, 0.92; 95% CI, 0.86-0.98) and indwelling urinary catheter utilization significantly decreased by 6% per year (OR, 0.94; 95% CI, 0.91-0.96). CONCLUSIONS AND RELEVANCERecent trends in CLABSI rates noted in this study among critically ill neonates and children in a large cohort of US hospitals indicate that past gains have held, without evidence of further improvements, suggesting novel approaches for CLABSI prevention are needed. Modest improvements in population-based CAUTI rates likely reflect more judicious use of urinary catheters.

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Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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Treatment and secondary prophylaxis with ethanol lock therapy for central line-associated bloodstream infection in paediatric cancer: a randomised, double-blind, controlled trial

Cited by 54 publications

References 29 publications

Ethanol lock therapy in pediatric patients: A multicenter prospective study

Ethanol lock therapy in pediatric patients: A multicenter prospective study

Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

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