COMPARISON OF 70% ETHANOL VERSUS HEPARIN LOCK IN TREATING TUNNELLED CATHETER RELATED BLOODSTREAM INFECTIONS IN HEMODIALYSIS PATIENTS - A RANDOMIZED CONTROLLED TRIAL

Introduction:

Catheter-related bloodstream infections (CRBSIs) pose a significant challenge in the management of patients undergoing hemodialysis with tunnelled catheters. Traditional treatments with antibiotics often fail to achieve optimal catheter salvage, leading to catheter removal and increased morbidity leading to an unmet need of newer modalities to prevent catheter removal. This study aimed to evaluate the efficacy and safety of ethanol lock therapy compared to heparin lock therapy in the treatment of CRBSI in patients undergoing hemodialysis.

Methods:

We conducted a double-blind, randomized controlled trial from May 2023 to May 2024 at a tertiary care centre. Forty-four hemodialysis patients with tunnelled internal jugular catheters and diagnosed CRBSI were randomized into two groups: Group 1 received 70% ethanol lock therapy, and Group 2 received heparin lock therapy, both in addition to systemic antibiotics. Lock therapy was applied daily for five consecutive days. Catheter salvage rates and microbiological cure at day 6 were the primary endpoints. Secondary outcomes included catheter salvage at day 28 and safety assessments

Results:

Forty-four patients were enrolled in the study and randomized in a double-blind fashion, with 22 patients in each group, forty patients were included in the final analysis. Mean age was 39.18 years (SD ± 14.39) with 67% males. The cohort had a mean dialysis vintage of 4.2 months, and 27.5% had diabetes. The majority of the infections was caused by gram-negative bacteria. Of this, Infections involving a single organism occurred in 67% of cases, while infections with two organisms were observed in 11% of cases. The most frequently isolated pathogen was Enterobacter cloacae, responsible for 37% of the cases. Gram-positive infections accounted for 18%, primarily Staphylococcus hemolyticus. Microbiological cure was seen in 45% in ethanol lock compared to 30% in heparin group. Catheter removal occurred in 55% of patients in the ethanol group versus 70% in the heparin group (p=0.327). Catheter salvage rates at 6 and 28 days were 45% and 30% in the ethanol group versus 30% and 25% in the heparin group (p=0.431 and p=0.72, respectively). Though ethanol therapy showed numerically higher rates of catheter salvage and microbiological cure, these differences were not statistically significant.

Conclusions:

The study suggests that 70% ethanol lock therapy may offer an advantage over heparin lock therapy in treating CRBSI, with higher but non-significant rates of microbiological cure and catheter salvage. Ethanol lock therapy demonstrated favourable safety profiles and presents a cost-effective alternative in resource-limited settings. However, larger studies are needed to confirm these findings and to evaluate long-term outcomes. Given the increasing resistance patterns observed, particularly among gram-negative organisms, ethanol lock therapy may be a promising adjunct to systemic antibiotics for improving CRBSI outcomes in hemodialysis patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.