Ethanol lock therapy in pediatric patients: A multicenter prospective study

Area of Science:

• Infectious Diseases
• Medical Devices
• Pharmacology

Background:

• Central venous catheter-related blood stream infections (CRBSI) pose a significant risk in patients with long-term indwelling catheters.
• Ethanol lock therapy (ELT) is a potential strategy to preserve central venous catheters (CVCs) in CRBSI cases, but its efficacy requires established evidence.
• A multicenter, prospective study was designed to evaluate the safety and effectiveness of a specific ELT protocol for CRBSI management.

Purpose of the Study:

• To ascertain the safety and effectiveness of a standardized ethanol lock therapy (ELT) protocol in managing central venous catheter-related blood stream infections (CRBSI).
• To evaluate the catheter salvage rate and the incidence of CRBSI relapse within four weeks post-treatment.

Main Methods:

• A prospective, multicenter study enrolled 49 patients over 1 year old with long-term indwelling silicone CVCs at risk for CRBSI.
• A 70% ethanol lock was administered daily for 2-4 hours over 7 days after catheter blood cultures.
• Outcomes assessed included ELT effectiveness for single and multiple courses, CRBSI relapse within 4 weeks, and CVC preservation for at least 4 weeks.

Main Results:

• Ethanol lock therapy (ELT) demonstrated an 88% effectiveness rate in treating central venous catheter-related blood stream infections (CRBSI) with a single course.
• Catheter blockage occurred in one case, necessitating removal; subsequent ELT courses were ineffective in the remaining cases.
• No CRBSI relapse was observed in 93% of cases up to 4 weeks post-treatment, and 84% of catheters were preserved for 4 weeks or longer. Transient facial flushing was the only reported adverse event.

Conclusions:

• The studied ethanol lock therapy (ELT) protocol is effective in treating central venous catheter-related blood stream infections (CRBSI), achieving an 88% success rate.
• The protocol facilitates catheter preservation in 84% of cases, indicating its utility in managing CRBSI and maintaining CVC functionality.
• ELT is considered a useful therapeutic option for CRBSI, with a favorable safety profile.