Abstract
The aim of this study was to prospectively evaluate the use of intraluminal ethanol for the prevention of catheter-associated bloodstream infection (CABSI) in immunosuppressed haematology patients. Patients receiving chemotherapy for haematological malignancy or haematopoietic cell transplantation were randomized in a double-blinded manner to receive either intraluminal 70% ethanol/water or heparinized saline locks on a daily basis throughout a prophylactic treatment period. The primary endpoint was an episode of CABSI (defined as 'bacteraemia in a febrile patient with a central venous catheter that was in use within the preceding 48 h and with no other identified focus of infection'). The trial was registered with the Australian Clinical Trials Register: number ACTRN012605000383662. There were 34 and 30 prophylactic treatment periods in the ethanol and control groups, respectively. CABSI occurred in 3 (9%, 0.60/100 catheter-days) and 11 (37%, 3.11/100 catheter-days) prophylactic treatment periods in the ethanol and control groups, respectively (OR = 0.18, 95% CI 0.05-0.65, P = 0.008). Eleven (32%) and 5 (17%) patients in the ethanol and control groups, respectively, remained afebrile throughout the prophylactic treatment (P = 0.18). The daily administration of ethanol locks into lumens of central venous catheters effectively reduces the incidence of CABSI.
Highlights
Central venous catheters play a pivotal role in the delivery of care to immunocompromised patients requiring treatment such as blood products, chemotherapy, parenteral nutrition, broadspectrum antibiotics and antiviral agents
The principal finding was a highly significant difference in laboratory-confirmed bloodstream infections (BSIs) rates between the two treatment groups, with 4-fold fewer episodes of catheter-associated bloodstream infection (CABSI) in the group receiving ethanol compared with the control group (Table 2)
The catheter is more strongly incriminated as the source of BSI in the clinical entity called catheterrelated BSI, which is defined as bacteraemia in a patient with an intravascular catheter with at least one positive blood culture obtained from a peripheral vein, clinical manifestations of infection and no apparent source for the BSI except the catheter
Summary
Central venous catheters play a pivotal role in the delivery of care to immunocompromised patients requiring treatment such as blood products, chemotherapy, parenteral nutrition, broadspectrum antibiotics and antiviral agents. Despite advances in catheter insertion and post-insertion care, catheter infection remains a major complication, causing significant morbidity and mortality. In the intensive care setting, catheter infection is associated with a mortality rate of 12% to 25%.1,2. Most nosocomial bloodstream infections (BSIs) are associated with the use of intravascular devices, and in patients receiving chemotherapy for haematological malignancy, 10% to 20% of tunnelled catheters become infected.[3,4] While catheter infection is common, the diagnosis can be difficult and catheters may be unnecessarily removed for suspected but unconfirmed sepsis. In the intensive care setting, catheter infection is associated with a mortality rate of 12% to 25%.1,2 In children, most nosocomial bloodstream infections (BSIs) are associated with the use of intravascular devices, and in patients receiving chemotherapy for haematological malignancy, 10% to 20% of tunnelled catheters become infected.[3,4] While catheter infection is common, the diagnosis can be difficult and catheters may be unnecessarily removed for suspected but unconfirmed sepsis.
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