Ethanol Lock Therapy as additional treatment of catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition

Abstract

Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.