M-EDTA/ETOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to CVC removal/reinsertion group who received longer duration of systemic antimicrobial therapy” Raad et al (2016).
In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that M-EDTA-ETOH lock may eradicate microbial organisms in biofilm and, hence, enabling the treatment of central line associated bloodstream infections (CLABSI) while retaining the catheter in situ.
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Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with M-EDTA/ETOH solution for 2 hours administered once daily for a total of 7 doses. Patients who received locks had comparable clinical characteristics to the control group. Time to fever resolution and microbiological eradication was similar in both groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy compared to control patients (median 11 days vs 16 days; P<0.0001). They were able to retain their CVC for a median of 74 days after the onset of bacteremia. M-EDTA/ETOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to CVC removal/reinsertion group who received longer duration of systemic antimicrobial therapy.
Raad, I., Chaftari, A.M., Zakhour, R., Jordan, M., Al Hamal, Z., Jiang, Y., Yousif, A., Garoge, K., Mulanovich, V., Viola, G.M., Kanj, S., Pravinkumar, E., Rosenblatt, J. and Hachem, R. (2016) Successful Salvage of Central Venous Catheters in the Setting of Catheter Related or Central Line Associated Bloodstream Infections Using Catheter Lock Consisting of Minocycline, EDTA and 25% Ethanol. Antimicrobial Agents and Chemotherapy. March 21st. [Epub ahead of print].
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