Ethanol lock therapy for salvage of infected tunnelled haemodialysis catheters: a randomised controlled trial

Tunnelled catheter-related bloodstream infections (CRBSIs) in haemodialysis (HD) are challenging to manage due to biofilm formation. Ethanol lock therapy (ELT) has demonstrated potential as an adjunct to antibiotics for catheter salvage, but robust evidence is limited.

We conducted a single-centre, open-label, randomised controlled trial of adult HD patients with suspected or confirmed CRBSI. Patients received either 70% ELT plus intravenous antibiotics or intravenous antibiotics alone. Primary outcome was catheter salvage at day 7. Secondary outcomes included recurrence at day 60, catheter survival and adverse events.

Eighty-four patients were randomised (42 per arm). Coagulase-negative Staphylococcus was the most common pathogen (34.5%). Early catheter salvage was higher with ELT (78.6% versus 57.1%; P = .035). Recurrence was lower with ELT at day 60 (20.5% versus 53.7%; P = .002). The median catheter survival was longer (15 versus 8 days), although not statistically significant (P = .283). Fever resolution by day 7 was significantly higher in the ELT group compared with controls (64.3% versus 35.7%; P = .009). Adverse events were infrequent and mild. In multivariate analysis, higher serum albumin was independently associated with an increased likelihood of catheter salvage [odds ratio (OR) 2.43, P = .038], while longer dialysis vintage (OR 0.90, P = .035) and Pseudomonas infection (OR 0.05, P = .014) were associated with reduced salvage rates.

Adjunctive ELT improved early catheter salvage and reduced recurrence without significant adverse effects. These findings support its use as part of salvage protocols in tunnelled catheter infections.