Management of central line-associated bloodstream infections with 70% ethanol-lock therapy

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#IVTEAM #Intravenous literature: Kubiak, D.W., Gilmore, E.T., Buckley, M.W., Lynch, R., Marty, F.M. and Koo, S. (2014) Adjunctive management of central line-associated bloodstream infections with 70% ethanol-lock therapy. The Journal of Antimicrobial Chemotherapy. February 12th. [epub ahead of print].

Abstract:

OBJECTIVES: Ethanol is bactericidal against most pathogens implicated in central line-associated bloodstream infections (CLABSIs) and biofilms. Current Infectious Diseases Society of America guidelines cite insufficient evidence to support adjunctive ethanol-lock therapy (ELT) for central venous catheter (CVC) salvage in patients with CLABSI in combination with systemic antimicrobial treatment. We evaluated the safety and potential efficacy of 70% ELT for CLABSI at our institution after implementation of a hospital ELT protocol.

METHODS: We collected data on all patients treated with adjunctive 70% ELT for catheter salvage from September 2009 to September 2011 and assessed clinical outcomes and adverse events associated with ELT.

RESULTS: Sixty-eight hospitalized patients received 70% ELT for CVC salvage: 45 (66%) met the criteria for CLABSI. Five (11%) had persistent or recurrent bacteraemia triggering CVC removal; 28 (62%) preserved their CVC long term. There were no documented adverse events associated with ELT.

DISCUSSION: Adjunctive 70% ELT is an inexpensive, well-tolerated option for CVC salvage in patients with CLABSI and warrants further investigation.

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