Introduction:
Catheter-related bloodstream infections (CRBSIs) pose a significant risk to patients requiring long-term vascular access, often leading to severe complications. Ethanol lock solutions (ELS) have shown potential in preventing and treating CRBSIs by disrupting biofilms and enhancing antimicrobial efficacy. A randomized controlled trial (RCT) is proposed to evaluate the effectiveness of ELS in salvaging tunneled catheters. This study aimed to compare catheter salvage rates in patients with tunneled catheter-related infections treated with a 70% ethanol lock solution (ELS) plus standard intravenous antibiotics versus standard care alone. Secondary objectives included comparing mortality rates, studying the clinical and microbiological profiles of infections, and identifying associated risk factors.
Methods:
This was a prospective, open label randomized controlled trial conducted in the Department of Nephrology at ABVIMS and Dr. RML Hospital, New Delhi. The study enrolled 60 patients (30 per group) on maintenance hemodialysis with tunneled catheter infections from July 2023 to July 2024. Patients were clinically defined by presence fever and intradialytic chills. Patients were randomized into two groups: one receiving 70 percent ethanol locking for 5 days plus standard antibiotic therapy, and the other receiving standard antibiotic therapy alone. Patients who were hemodynamically unstable, metastatic infections and who had tunnel infections were excluded from the study. Follow-up was conducted over 60 days to assess outcomes, including catheter salvage rates, microbiological profiles, and mortality. Statistical analysis was performed using SPSS.
Results:
Among the 60 patients with clinically defined catheter-related bloodstream infections, the mean age was 46 years, with a predominance of females (67.2%). A total of 37 out of 60 catheters were salvaged. In the ethanol group, 22 catheters were salvaged compared to 15 in the control group on Day 7 (p = 0.066); 18 versus 11 catheters were salvaged on Day 15 (p = 0.26); 17 versus 10 on Day 30 (p = 0.266); and 17 versus 9 catheters were salvaged on Day 60 (p = 0.23). Thirty-two percent of cultures were sterile. Twenty-five percent of cultures grew coagulase-negative staphylococcus, with the remainder including Klebsiella (19%), Staphylococcus aureus (1.7%), Pseudomonas (15%), Enterobacter (1.7%), E. coli (1.7%), and Citrobacter (1.7%). In the ethanol locking group, there were zero recurrences by Day 30 compared to three in the control group (p = 0.165), and two versus five recurrences by Day 60 (p = 0.132). There were 2 deaths in the ethanol group versus 1 in the control group, in 60 days of follow up. Two patients in the ethanol locking group experienced flushing. Additionally, two patients in the ethanol locking group developed catheter-related thrombi, necessitating thrombolysis
Conclusions:
Present study shows that Ethanol locking can be safely used to manage tunneled catheter related infections and reduce recurrence.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.