#6738 ALCOHOL LOCK IN CRBSI: A PANACEA

Abstract

Abstract Background and Aims CRBSI is a dreaded complication of permcath, with a reported incidence of 1.1 – 5.5 episodes/1000 days. Many of these patients especially those infected with Staphylococcus aureus, Pseudomonas aeruginosa or fungal growth require catheter removal. 70% alcohol possibly breaks the biofilm in the catheter and exposes hidden bacteria to antibiotics. This study was done to find the usefulness of 70% alcohol lock in patients with established CRBSI. Method All dialysis patients in our centre with permcath as vascular access were the subjects of the study. All patients were given heparin lock after each dialysis session. CRBSI was diagnosed as per CDC/IDSA criteria. All patients with CRBSI in addition to antibiotics were also given 70% alcohol lock (2 ml in each port) for 3 consecutive days. Outcome of these patients in term of clinical response and need for catheter removal was studied. The catheter outcome of this group was compared with our patients (retrospective controls) who were given only antibiotics and not given alcohol lock. Results Over last two years 166 permcaths were placed in our institution. Eighty nine of them continued dialysis in our centre. Their total follow up period was 12028 days (30-720 days). There were 18 episodes of CRBSI in 14 of these patients (1.5 episodes per 1000 catheter days). Three of these patients (16.67%) required catheter removal, rest all improved with antibiotics and alcohol lock. Over a follow up of 150 days (30 -420 days), these patients have been doing well and there has been no episode of catheter leak or break or block. On comparing with our retrospective control of 22 patients with CRBSI, who were not given alcohol lock, 15 (68.18%) required catheter removal (P = 0.001). Conclusion The present study though on small numbers, shows that alcohol lock works as a boon in the setting of established CRBSI. It avoids catheter removal in majority of patients.